周京敏－感染性心内膜炎.ppt

感染性心内膜炎 InfectiveEndocarditis 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 几乎均有心脏病基础PVE 表皮葡萄球菌 术后1年内 Endocarditis Heartstructuralabnormality Endocardialinjury thrombosis Adhesionofbacteria Disturbanceofbloodflow Mechanism vegetation Systematicembolism abscess Endocarditis Kidney Liver Jointdiseases Immunesystemactivation Pathology Thrombusandbacteria ClinicalManefestation 全身表现 发热 高热 低热 无发热乏力 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免疫反应表现 OftenseeninSIENocharacteristicsOslernode Toth ClinicalManefestation EmboliclesionsonthefeetofapatientwithStaphylococcusaureusendocarditis SkinandNailLesionsinstaphylococcalendocarditis Typicalsubungual splinter hemorrhageandnumerouspetechiaeontheskinoftheabdomen Labfindings Bloodculture MostimportantdiagnosticmethodVeinbloodX3timesNegativedoesnotexcludethediagnosis Gramstainedsmearfrombloodculturebottleshowingviridansstreptococcifromptwithnativevalveendocarditis Echocardiography TTE TEE moreusefulVegetationAVorMVinsufficiencyAbscese AortarootabscessinTEEstudy PerivalvarabscessofMVannulus andperforation Vegetation Diagnosis TheConceptionofIEFever 1weekinptswithstructuralheartdiseasesorheartoperationTheappearanceorchangeofcardiacmurmurSystematicembolismwithnoobviouscauseHeartfailurewithnoobviouscause Management Antibiotics 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 手术治疗没有办法之办法应掌握好指证 seeP315该开不开也不对 Management 3 对症治疗内科医生具备的常规知识HeartfailureSystematicembolismArrhythmias Arterialaneurysm depends Management 治愈标准症状改善体征 anemia spleen cardiacmurmurLab anemia Urineproteinbloodculture 1 2 6w Management Recurrence samebacteriaRepeatantibiotics Prevention预防性应用抗生素PrognosisMortality AIE 20 50 SIE 20 5 yearsurvival 90 A56 ymanSeverelumbarpain a7 wfever 39 C anda10 kgweightlossHistory HBPwithdilatedLV reducedLVEF andMR pE agrade3 6holo SM andevidenceofsciatica 坐骨神经痛 Casediscussion WBC 15 400mm3CRP 12 1mg dLBloodcultures negativeLumbosacralMRI non specificTreatedwithanalgesicmedicationandphysicaltherapy 12thDay Lefthemiplegia CTofthehead recentinfarctionintheterritoryoftherightmiddlecerebralartery Whatisthenextstep TEE 35 5mm mobile Veget