感染性心內膜炎InfectiveEndocarditis第1頁Definitionandclassification心（血管）內膜（瓣膜）感染急性(AIE)：毒力強，病程短，中毒癥狀明顯亞急性（SIE,SBE)：毒力低，病程長自體瓣膜感染：nativevalveendocarditis人工瓣膜感染：prostheticvalveendocarditis(PVE)右心瓣膜感染性心內膜炎rightheartvalveendocarditis:drugabuse,AIDS,catheterization第2頁EtiologyandMechanism草綠色鏈球菌，50%葡萄球菌，葛蘭氏陰性桿菌AIE：葡萄球菌，可發(fā)生于無器質性心臟病患者SIE：鏈球菌，esp.院外感染，幾乎均有心臟病基礎PVE：表皮葡萄球菌，術后1年內第3頁EndocarditisHeartstructuralabnormalityEndocardialinjurythrombosisAdhesionofbacteriaDisturbanceofbloodflowMechanism第4頁vegetationSystematicembolism,abscessEndocarditisKidney,Liver,JointdiseasesImmunesystemactivationPathologyThrombusandbacteria第5頁ClinicalManefestation全身體現：發(fā)熱，高熱，低熱，無發(fā)熱乏力，多汗，貧血，體重減輕，食欲不振心臟：MurmurappearanceorchangeHeartfailureArrhythmia:heartblock,severe第6頁血管損害：SystematicembolismSkin:petechiaeSpleen,kidney,limbs,Brain,Messentricembolism免疫反映體現：OftenseeninSIENocharacteristicsOslernode,TothClinicalManefestation第7頁EmboliclesionsonthefeetofapatientwithStaphylococcusaureusendocarditis第8頁SkinandNailLesionsinstaphylococcalendocarditis.Typicalsubungual("splinter")hemorrhageandnumerouspetechiaeontheskinoftheabdomen第9頁LabfindingsBloodculture:MostimportantdiagnosticmethodVeinbloodX3timesNegativedoesnotexcludethediagnosis

第10頁Gramstainedsmearfrombloodculturebottleshowingviridansstreptococcifromptwithnativevalveendocarditis第11頁EchocardiographyTTE:TEE:moreusefulVegetationAVorMVinsufficiencyAbscese第12頁AortarootabscessinTEEstudy第13頁PerivalvarabscessofMVannulus,andperforation第14頁Vegetation第15頁DiagnosisTheConceptionofIEFever>1weekinptswithstructuralheartdiseasesorheartoperationTheappearanceorchangeofcardiacmurmurSystematicembolismwithnoobviouscauseHeartfailurewithnoobvious

cause第16頁ManagementAntibiotics:原則：初期、足量、聯(lián)合、殺菌、4-6周根據藥敏選擇經驗性：院外：鏈球菌：青霉素院內：葡萄球菌：頭孢唑林+丁卡第17頁2.手術治療沒有措施之措施應掌握好指證：seeP315該開不開也不對Management第18頁3.對癥治療內科醫(yī)生具有旳常規(guī)知識HeartfailureSystematicembolismArrhythmias:Arterialaneurysm:dependsManagement第19頁治愈原則癥狀改善體征：anemia,spleen,cardiacmurmurLab:

anemia,Urineproteinbloodculture(-):1,2,6wManagementRecurrence:samebacteriaRepeatantibiotics第20頁Prevention防止性應用抗生素PrognosisMortality:AIE:20-50%SIE:20%5-yearsurvival:90%第21頁A56-ymanSeverelumbarpain,a7-wfever(<39°C),anda10-kgweightlossHistory:HBPwithdilatedLV,reducedLVEF,andMR+—++pE:agrade3/6holo-SM,andevidenceofsciatica（坐骨神經痛）Casediscussion第22頁WBC:15,400mm3CRP:12.1mg/dLBloodcultures:negativeLumbosacralMRI:non-specificTreatedwithanalgesicmedicationandphysicaltherapy第23頁12thDay:LefthemiplegiaCTofthehead:recentinfarctionintheterritoryoftherightmiddlecerebralartery.Whatisthenextstep?TEE第24頁35*5mm:mobileVegetationo