感染性心内膜炎宣讲培训课件.ppt

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1、感染性心内膜炎宣讲,感染性心内膜炎宣讲,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,感染性心内膜炎宣讲,2,Definition and classificatio

2、n心,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,感染性心内膜炎宣讲,3,Etiology and Mechanism草绿色链球菌，5,Endocarditis,Heart structural abnormality,Endocardial injury,thrombosis,Adhesion of bacteria,Disturbance of blood flow,Mechanism,感染性心内膜炎宣讲,4,En

3、docarditisHeart structuralEn,vegetation,Systematic embolism, abscess,Endocarditis,Kidney, Liver, Joint diseases,Immune system activation,Pathology,Thrombus and bacteria,感染性心内膜炎宣讲,5,vegetationSystematic embolism,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 changeH

4、eart failureArrhythmia: heart block, severe,感染性心内膜炎宣讲,6,Clinical Manefestation全身表现：感染性,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, Toth,Clinical Manefestation,感染性心内膜炎宣讲,7,血管损害：Systematic embolismClinic,E

5、mbolic lesions on the feet of a patient with Staphylococcus aureus endocarditis,感染性心内膜炎宣讲,8,Embolic lesions on the feet of,Skin and Nail Lesions in staphylococcal endocarditis.Typical subungual (splinter) hemorrhage and numerous petechiae on the skin of the abdomen,感染性心内膜炎宣讲,9,Skin and Nail Lesions

6、in staph,Lab findings,Blood culture:Most important diagnostic methodVein blood X 3 times Negative does not exclude the diagnosis,感染性心内膜炎宣讲,10,Lab findingsBlood culture:感染性心,Gram stained smear from blood culture bottle showing viridans streptococci from pt with native valve endocarditis,感染性心内膜炎宣讲,11,

7、Gram stained smear from blood,感染性心内膜炎宣讲培训课件,Aorta root abscess in TEE study,感染性心内膜炎宣讲,13,Aorta root abscess in TEE stud,Perivalvar abscess of MV annulus, and perforation,感染性心内膜炎宣讲,14,Perivalvar abscess of MV annul,Vegetation,感染性心内膜炎宣讲,15,Vegetation感染性心内膜炎宣讲15,Diagnosis,The Conception of IEFever 1 we

8、ek 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,感染性心内膜炎宣讲,16,DiagnosisThe Conception of IE感,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,

9、感染性心内膜炎宣讲,17,ManagementAntibiotics:感染性心内膜炎宣,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,感染性心内膜炎宣讲,18,2. 手术治疗Management感染性心内膜炎宣讲18,3. 对症治疗内科医生具备的常规知识Heart failureSystematic embolismArrhythmias:Arterial aneurysm: depends,Management,感染性心内膜炎宣讲,19,3. 对症治疗Management感染性心内膜炎宣讲19,治愈标准症状改善体征：anemia, splee

10、n, cardiac murmurLab: anemia, Urine proteinblood culture (-): 1,2,6 w,Management,Recurrence: same bacteriaRepeat antibiotics,感染性心内膜炎宣讲,20,治愈标准ManagementRecurrence: 感染性心,Prevention预防性应用抗生素PrognosisMortality: AIE: 20-50%SIE: 20%5-year survival: 90%,感染性心内膜炎宣讲,21,Prevention感染性心内膜炎宣讲21,A 56-y man Severe

11、lumbar pain, a 7-w fever (39C), and a 10-kg weight lossHistory: 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,感染性心内膜炎宣讲,22,A 56-y man Case discussion感染性心,WBC: 15,400 mm3CRP : 12.1 mg/dLBlood cultures: negativeLumbosacral MRI:

12、non-specific Treated with analgesic medication and physical therapy,感染性心内膜炎宣讲,23,WBC: 15,400 mm3感染性心内膜炎宣讲23,12th Day: Left hemiplegia,CT of the head:,recent infarction in the territory of the right middle cerebral artery.,What is the next step?,TEE,感染性心内膜炎宣讲,24,12th Day: Left hemiplegia CT o,35 * 5 mm: mobile,Vegetation on the anterior MV,感染性心内膜炎宣讲,25,35 * 5 mm: mobileVegetation on,The patient recovered and was discharged two weeks later.,3rd month follow-up visit, only slight, left-sided muscular weakness.,感染性心内膜炎宣讲,26,The patient recovered and was,