【摘要】：目的:探討心臟超聲在感染性心內(nèi)膜炎(IE)診斷中的應(yīng)用價值。方法:入選2013-01至2015-06就診于本中心初步診斷為心血管植入式電子裝置(CIED)感染的患者共478例。其中,根據(jù)癥狀、常規(guī)血培養(yǎng)、心臟超聲檢查疑似IE者9例,進一步接受正電子發(fā)射計算機斷層攝影術(shù)(PET-CT)檢查,以明確診斷及分型。然后,根據(jù)診斷分別進行針對性治療,隨訪一年,檢驗心臟超聲檢查對CIED患者IE診斷的準確性。結(jié)果:3例患者因心臟超聲未發(fā)現(xiàn)贅生物而初步診斷為菌血癥,但經(jīng)PET-CT檢查后最終診斷為IE。2例患者心臟超聲提示瓣膜贅生物而初步診斷為IE,但經(jīng)PET-CT檢查后發(fā)現(xiàn)心腔內(nèi)電極導(dǎo)線及瓣膜均未見贅生物,其中1例伴隨血培養(yǎng)陽性,最終診斷為菌血癥,另1例無感染征象者最終診斷為非感染患者。4例患者在電極導(dǎo)線拔除術(shù)后因心臟超聲可見贅生物而初步診斷為IE,但PET-CT檢查發(fā)現(xiàn)心腔內(nèi)無感染征象,最終確定為"非感染性纖維殘留組織"。根據(jù)最終診斷分別采取針對性治療,隨訪至少1年,所有患者均未出現(xiàn)新增感染及感染復(fù)發(fā)。結(jié)論:心臟超聲對心腔內(nèi)贅生物的判定存在誤差,尤其對于接受電極導(dǎo)線拔除術(shù)后的疑似IE患者,應(yīng)結(jié)合其他檢查方法進行確定診斷,制定正確的治療策略。
[Abstract]:Objective: to evaluate the value of echocardiography in (IE) diagnosis of infective endocarditis. Methods: from January 2013 to June 2015, 478 patients with (CIED) infection of cardiovascular implantable electronic device were enrolled in the center. According to the symptoms, routine blood culture and echocardiography, 9 patients with suspected IE were further examined by positron emission computed tomography (PET-CT) in order to confirm the diagnosis and classification. Then, according to the diagnosis of targeted treatment, follow-up for one year, to test the accuracy of cardiac ultrasound in the diagnosis of CIED patients with IE. Results: three patients were initially diagnosed as bacteremia because no vegetations were found by echocardiography, but after PET-CT examination, the patients were diagnosed as valve vegetations in IE.2 patients, and the initial diagnosis was IE,. However, after PET-CT examination, no vegetations were found in the electrodes and valves in the cardiac cavity, one of them was positive with blood culture, and the final diagnosis was bacteremia. The other one with no sign of infection was diagnosed as non-infected. After electrode wire extraction, 4 patients were initially diagnosed as IE, because of the vegetations of cardiac ultrasound, but no signs of infection were found in the heart cavity by PET-CT, but no signs of infection were found in the heart cavity of 4 patients after electrode wire extraction. Finally identified as "non-infective fiber residue tissue". According to the final diagnosis, the patients were followed up for at least 1 year, and no new infection and recurrence were found in all patients. Conclusion: there are errors in the diagnosis of intracavitary vegetations by echocardiography, especially for patients with suspected IE after electrode wire extraction, the diagnosis should be made in combination with other methods, and the correct treatment strategy should be worked out. [WT5 "HZ] conclusion: [WT5" BZ] [WT5 "BZ]
【作者單位】： 北京大學(xué)人民醫(yī)院心臟中心;北京安貞醫(yī)院;
【基金】：科技部國家科技支撐計劃(2014BAI11B08)
【分類號】：R542.4

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