感染性心内膜炎.ppt

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1、UpdateonInfectiveEndocarditis7/981medslides.comPathogenesisDisruptionoftheendocardiallayerasacomplicationofabnormalbloodflowassociatedwithunderlyingcardiacdefectBacterium-endotheliuminteractionwithbacterialattachmentandinvasionofendothelialcells7/982medslides.comEpidemiologyU

2、nderlyingvalvularabnormalitypredisposingtoinfectiveendocarditisrheumaticfeveracommoncauseinthepastmitralvalveprolapsecurrentlyrepresentsthemostcommonunderlyingcardiacabnormality7/983medslides.commitralvalveprolapseriskforinfectiveednocarditisis5x-8xmitralregurgitationincrease

3、stheriskleafletredundancywithmyxomatousdegenerationisafrequentfindingage<20,femalepredominateage>20,maleaccountsfor60%age>50,maleaccountsfor68%7/984medslides.comMitralValveProlapseandInfectiveEndocarditisMaleFemaleNumberofcasesRevInfectDis1986;8:117-1377/985medslides.comCoag

4、ulase-negativeStaphylococcicanproducenative-valveendocarditisinmitralvalveprolapseusuallysubacute,difficulttodiagnose,anddisregardedasacontaminantdelayindiagnosisandtreatmentmayaccountfortheseverecomplicationsmyocardialabscessformationvalvularinsufficiencyrequiringvalvesurgery

5、death7/986medslides.comProstheticHeartValvepositivebloodcultureinhospitalizedpatientswithunderlyingprostheticvalvescanbeaharbingerofendocarditis43%patientswithnosocomialbacteremiaorfungemiahadprostheticvalveinfectionaseriouscomplication7/987medslides.comIVDrugUseRecurrentPolym

6、icrobialStaphaureusaccountsforthemajorityofcasesofendocarditistricuspidvalve,eitheraloneorincombination,usmostofteninfected7/988medslides.comPredisposingFactorsPolymicrobialInfectiveEndocarditis7/989medslides.comPolymicrobialInfectiveEndocarditisclinicalfeaturesIVdruguseisthep

7、redominantriskfactoryoungerage(mean36.5years)2/3weremaleright-sidedcardiacinvolvementin>60%streptococcimorefrequentthanS.aureus1/3ofpatientsdiedmortalityrateis4xhigherforpureleft-sidesvspureright-sidedendocarditis7/9810medslides.comDiagnostic(Duke)CriteriaDefinitiveinfectiveen

8、docarditispathologiccriteriamicroorganismsorpathologiclesions