Infective Endocarditis in a District General Hospital
Infective Endocarditis in a District General Hospital
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某区总医院感染性心内膜炎
DOI：
10.1177/014107689208500507
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发表时间：
1992
影响因子：
17.3
通讯作者：
K. Farrington
中科院分区：
文献类型：
--
作者：
M. Manford;J. Matharu;K. Farrington
本文对某区综合医院6.5年间收治的33例感染性心内膜炎进行了回顾性分析。年发病率为每百万人口22例。22例病例有既存心脏病，主要是瓣膜疾病-通常是风湿性（9例）和人工瓣膜（10例）。可识别的诱因，如最近的手术是罕见的。2例病例在故意药物过量后出现，可能是由于全身性疾病加重的抑郁症。症状通常是非特异性的。除2例外，所有病例均有杂音，大多数为发热。约20%的病例可见碎片状出血和杵状突起。草绿色型链球菌是最常见的感染菌（14例）。葡萄球菌感染（6例）仅限于静脉吸毒者和人工瓣膜患者。5例培养阴性。13例患者在就诊时出现了心脏衰竭，另外7例在治疗过程中出现了心脏衰竭。急性瓣膜置换术8例，晚期瓣膜置换术3例。19例患者在病程中出现肾损害（血尿素> 8 mmol/l和/或血肌酐> 120 μmol/l）。12例患者发生栓塞现象，大多数累及中枢神经系统。在8例死亡病例中，6例死亡原因为心力衰竭，1例为脑血管意外，1例为心肌梗死。随后死于心力衰竭的6名患者中有4名被转诊接受手术。这两个没有被转诊的人都有并存的医疗问题。与死亡率增加相关的因素有年龄、男性、心力衰竭（P<0.01）、肾损害（P<0.05）和栓塞现象（P< 0.01）。这些结果数据与区域中心报告的结果相似，并支持地区综合医院对感染性心内膜炎的管理，特别是那些能够充分获得超声心动图的医院，必要时可转手术。
Thirty-three cases of infective endocarditis presenting during a 6.5 year period to a district general hospital were analysed retrospectively. The annual incidence was 22 cases per million population. Twenty-two cases had pre-existing cardiac disease, mainly valvular disease — Usually rheumatic (nine cases) and prosthetic valves (10 cases). Recognizable precipitants such as recent surgery were uncommon. Two cases presented after deliberate drug overdose possibly due to depression exacerbated by systemic disease. Symptoms were usually non-specific. All but two cases had murmurs and most were pyrexial. Splinter haemorrhages and clubbing were seen in about 20% of cases. Viridans-type streptococci were the commonest infecting organisms (14 cases). Staphylococcal infection (six cases) was confined to intravenous drug abusers and patients with prosthetic valves. Five cases were culture negative. Cerdiac failure was present in 13 cases at presentation and developed in seven others during treatient. Acute valve replacement was necessary in eight cases, and late replacement in three. Renal impairment (plasma urea > 8 mmol/l and/or plasma creatinine > 120 μmol/l) occurred in 19 cases during the course of their illness. Embolic phenomena occurred in 12 patients and mostly involved the central nervous system. In the 8 fatal cases, the cause of death was cardiac failure in six, cerebrovascular accident in one, and myocardial infarction in one. Four of the six patients who subsequently died of cardiac failure had been referred for surgery. Both those who were not referred had coexisting medical problems. Factors associated with increased mortality were age, male sex, cardiac failure (P<0.01), renal impairment (P<0.05), and embolic phenomena (P< 0.01). These outcome figures are similar to those reported from regional centres, and support the management of infective endocarditis in district general hospitals, particularly those with adequate access to echocardiography, with transfer for surgery when necessary.