Clinical Manifestation of Infective Endocarditis

感染性心內膜炎的臨床表現

黃英傑(Ying C. Huang) ； 張順清(Shun-Ching Cheung) ； 林仁風(Jen-Feng Lin) ； 楊智穎(Chih-Ying Yang) ； 許國忠(Kuo-Chung Hsu) ； 張瑞月(Jui-Yueh Chang) ； 陳澄鋆(Cheng-Yun Chen) ； 黃慶琮(Ching-Tsung Huang)

《中華民國急救加護醫學會雜誌》 12卷1期 (2001/03) Pp. 19-24

https://doi.org/10.30018/JECCM.200103.0003

摘要

感染性心內膜炎乃因微生物感染了心內膜所造成之疾病，臨床上的表現以全身性感染、血管內病變、免疫反應以及併發症為主。近年來因為醫學的進展及生活的變遷，這疾病的表現已經與昔日有相當的差異。要正確地診斷與治療這疾病，就必須要跟得上時代。
我們收集了自1997年五月至2000年五月期間，本院診治所有感染性心內膜炎的患者。唯有在本院診斷、且接受完整的治療與追蹤者，方得納入此研究。並就這些患者的臨床表現、危險因子、致病病原、瓣膜變化以及治療過程加以整理分析。
整理後得到八位患者，五男三女。年齡從25歲到72歲(49.8±13.7%)。這些患者中，七位因為發燒而來就診，兩位中風，另外一位則因肢體缺氧而來就診。他們的心臟都有雜音，七位患者血中白血球上升。五位患者一開始就被疑為感染性心內膜炎，另外三位則是經過一系列的檢查才得到診斷。這些患者中，五位已知有心臟瓣膜疾病，一位曾接受過人工瓣膜換置手術，一位有先天性二瓣性主動脈瓣，另一位則是靜脈藥癮者。血液細菌培養長出鏈球菌的有兩位，葡萄球菌的有四位，另外兩位則未長出細菌。經過治療，七位患者改善，一位患者則持續地惡化最後死亡。
感染性心內膜炎患者的表現與以前已經大不相同。如果您的患者因發燒、白血球增加或其他感染跡象而來就診，您務必仔細地詢問有無心瓣膜疾病或是靜脈藥物使用的病史，理學檢查時也必須仔細聆聽有無心雜音。如果患者有散播性栓塞、感染，或是初步檢找不出感染源者，最好慎重地考慮是否染有感染性心內膜炎。即時的診斷與治療，是成功治療感染性心內膜炎及減少損傷的不二法門。

關鍵字

感染性心內膜炎，微生物病原

並列摘要

Infective endocarditis is caused by microbial infection of the endocardium. Clinical manifestations come from systemic infections, intravascular lesions, immunological responses, and complications. However, this picture has changed dramatically in recent years.
We collected patients diagnosed with infective endocarditis, based on the Duke criteria, from May 1997 to May 2000 in our hospital. Clinical manifestations, risk factors, pathogens, the valve involved, and course of treatment were collected and analyzed.
There were 8 patients, 5 men and 3 women. Their ages ranged from 28 to 72 (mean 49.8±13.7 years). Seven presented with fever, two with stroke and one with limb ischemia without fever. All had cardiac murmur and seven had leukocytosis. Five were diagnosed initially with infective endocarditis and 3 were diagnosed after serial examinations. Among the risk factors, five had valvular diseases, one had valvular replacement, one had a bicuspid aortic valve and one was an intravenous drug abuser. Streptococcus was abtained from 2, staphylococcus from 4 and 2 had negative cultures. Seven improved after treatment, and one deteriorated and died.
If a patient presents with fever, leukocytosis or other manifestations of infection, a history of valvular disease or drug abuse , the clinician should search for cardiac murmur. Infective endocarditis should be considered when there is metatatic emboli/infection or no primary infection focus can be found. Early diagnosis and treatment lead to mortality reduction.

並列關鍵字

Infective endocarditis, microbial pathogens