感染性心内膜炎课件.pptVIP

感染性心内膜炎Infective Endocarditis Definition and classification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：native valve endocarditis人工瓣膜感染：prosthetic valve endocarditis (PVE)右心瓣膜感染性心内膜炎right heart valve endocarditis: drug abuse, AIDS, catheterization Etiology and Mechanism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 EndocarditisHeart structural abnormalityEndocardial injurythrombosisAdhesion of bacteriaDisturbance of blood flowMechanism vegetationSystematic embolism, abscessEndocarditisKidney, Liver, Joint diseasesImmune system activationPathologyThrombus and bacteria Clinical Manefestation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：Murmur appearance or changeHeart failureArrhythmia: heart block, severe 血管损害：Systematic embolismSkin: petechiaeSpleen, kidney, limbs,Brain,Messentric embolism免疫反应表现：Often seen in SIENo characteristics Osler node, TothClinical Manefestation Embolic lesions on the feet of a patient with Staphylococcus aureus endocarditis Skin and Nail Lesions in staphylococcal endocarditis.Typical subungual (splinter) hemorrhage and numerous petechiae on the skin of the abdomen Lab findingsBlood culture:Most important diagnostic methodVein blood X 3 times Negative does not exclude the diagnosis Gram stained smear from blood culture bottle showing viridans streptococci from pt with native valve endocarditis EchocardiographyTTE:TEE: more usefulVegetation AV or MV insufficiencyAbscese Aorta root abscess in TEE study Perivalvar abscess of MV annulus, and perforation Vegetation DiagnosisThe Conception of IEFever 1 week in pts with structural heart diseases or heart operationThe appearance or change of cardiac murmurSystematic embolism with no obvious causeHeart failure with no obvious cause 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. 手术治疗没有办法之办法应掌握好指证：see P315该开不开也不对Management 3. 对症治疗内科医生具备的常规知识Heart failureSystematic embolismArrhythmias:Arterial aneurysm: dependsManag