感染性心内膜炎宣讲.pptVIP

感染性心内膜炎宣讲

Definitionandclassification心（血管）内膜（瓣膜）感染急性(AIE)：毒力强，病程短，中毒症状明显亚急性（SIE,SBE)：毒力低，病程长自体瓣膜感染：nativevalveendocarditis人工瓣膜感染：prostheticvalveendocarditis(PVE)右心瓣膜感染性心内膜炎rightheartvalveendocarditis:drugabuse,AIDS,catheterization

EtiologyandMechanism草绿色链球菌，50%葡萄球菌，葛兰氏阴性杆菌AIE：葡萄球菌，可发生于无器质性心脏病患者SIE：链球菌，esp.院外感染，几乎都有心脏病基础PVE：表皮葡萄球菌，术后1年内

EndocarditisHeartstructuralabnormalityEndocardialinjurythrombosisAdhesionofbacteriaDisturbanceofbloodflowMechanism

vegetationSystematicembolism,abscessEndocarditisKidney,Liver,JointdiseasesImmunesystemactivationPathologyThrombusandbacteria

ClinicalManefestation全身体现：发烧，高热，低热，无发烧乏力，多汗，贫血，体重减轻，食欲不振心脏：MurmurappearanceorchangeHeartfailureArrhythmia:heartblock,severe

血管损害：SystematicembolismSkin:petechiaeSpleen,kidney,limbs,Brain,Messentricembolism免疫反应体现：OftenseeninSIENocharacteristicsOslernode,TothClinicalManefestation

EmboliclesionsonthefeetofapatientwithStaphylococcusaureusendocarditis

SkinandNailLesionsinstaphylococcalendocarditis.Typicalsubungual(splinter)hemorrhageandnumerouspetechiaeontheskinoftheabdomen

LabfindingsBloodculture:MostimportantdiagnosticmethodVeinbloodX3timesNegativedoesnotexcludethediagnosis

Gramstainedsmearfrombloodculturebottleshowingviridansstreptococcifromptwithnativevalveendocarditis

EchocardiographyTTE:TEE:moreusefulVegetationAVorMVinsufficiencyAbscese

AortarootabscessinTEEstudy

PerivalvarabscessofMVannulus,andperforation

Vegetation

Diagnosis

ManagementAntibiotics:原则：早期、足量、联合、杀菌、4-6周根据药敏选择经验性：院外：链球菌：青霉素院内：葡萄球菌：头孢唑林+丁卡

2.手术治疗没有方法之方法应掌握好指证：seeP315该开不开也不对Management

3.对症治疗内科医生具有旳常规知识HeartfailureSystematicembolismArrhythmias:Arterialaneurysm:dependsManagement

治愈原则症状改善体征：anemia,spleen,cardiacmurmurLab:anemia,Urineproteinbloodculture(-):1,2,6wManagementRecurrence:samebacteriaRepeatantibiotics

Prevention预防性应用抗生素PrognosisMortality:AIE:20-50%SIE:20%5-yearsurvival:9