感染性心内膜炎宣讲.pptx

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,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，几乎都有心脏病基础,PVE：,表皮葡萄球菌，术后1年内,Endocarditis,Heart structural,abnormality,Endocardial injury,thrombosis,Adhesion of bacteria,Disturbance,of blood flow,Mechanism,vegetation,Systematic embolism,abscess,Endocarditis,Kidney,Liver,Joint diseases,Immune system activation,Pathology,Thrombus and bacteria,Clinical Manefestation,全身体现：,发烧，高热，低热，无发烧,乏力，多汗，贫血，体重减轻，食欲不振,心脏：,Murmur appearance or change,Heart failure,Arrhythmia:heart block,severe,血管损害：Systematic embolism,Skin:,petechiae,Spleen,kidney,limbs,Brain,Messentric embolism,免疫反应体现：,Often seen in SIE,No characteristics,Osler node,Toth,Clinical 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 findings,Blood culture:,Most important diagnostic method,Vein 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,Echocardiography,TTE:,TEE:more useful,Vegetation,AV or MV insufficiency,Abscese,Aorta root abscess in TEE study,Perivalvar abscess of MV annulus,and perforation,Vegetation,Diagnosis,The Conception of IE,Fever 1 week in pts with structural heart diseases or heart operation,The appearance or change of cardiac murmur,Systematic embolism with no obvious cause,Heart failure with no obvious,cause,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,没有方法之方法,应掌握好指证：see P315,该开不开也不对,Management,3.对症治疗,内科医生具有旳常规知识,Heart failure,Systematic embolism,Arrhythmias:,Arterial aneurysm:depends,Management,治愈原则,症状改善,体征：,anemia,spleen,cardiac murmur,Lab:,anemia,Urine protein,blood culture(-):1,2,6 w,Management,Recurrence:,same bacteria,Repeat antibiotics,Prevention,预防性应用抗生素,Prognosis,Mortality:,AIE:20-50%,SIE:20%,5-year survival:90%,A 56-y man,Severe lumbar pain,a 7-w fever(39C),and a 10-kg weight loss,History:HBP with dilated LV,reduced LVEF,and MR+,+,pE:a grade 3/6 holo-SM,and evidence of sciatica（坐骨神经痛）,Case discussion,WBC:15,400 mm,3,CRP:12.1 mg/dL,Blood cultures:negative,Lumbosacral MRI:non-specific,Treated with analgesic medication and physical therapy,12,th,Day:Left hemiplegia,CT of the head:,recent infarction in the territory of the right middle cerebral artery.,What is the next step?,TEE,35*5 mm:mobile,Vegetation on the anterior MV,The patient recovered and was discharged two weeks later.,3rd month follow-up visit,only slight,left-sided muscular weakness.,