Clinical Features And Comparison Of Medical And Surgical Efficacies Of Infective Endocarditis In 80 Patients In A Tertiary Hospital

Objective To provide evidence for the diagnosis and treatment of infective endocarditis by analyzing the characteristics of infective endocarditis through literature review combined with etiology,clinical features,complications and prognosis analysis of patients with infective endocarditis in QianFoShan Hospital,Shandong province.Methods Clinical features of 80 patients with infective endocarditis hospitalized in our hospital from March 2014 to December 2018 were retrospectively analyzed,including demographic characteristics,heart disease,clinical manifestations,complications,pathogenic bacteria composition,echocardiographic manifestations,and comparison of internal and surgical treatments.Results Demographic characteristics:according to the inclusion criteria,the average onset age of 80 patients with infective endocarditis in our hospital was 51.2 years old,and the male to female ratio of infective endocarditis patients was about 2:1,most of them were middle-aged,and the proportion of young patients was slightly higher than that of elderly patients.Clinical manifestations and associated diseases:62 patients(77.5%)exhibited fever as the main symptom,of which 60 patients had a fever over 38? during the duration of the disease.Other common clinical manifestations include heart murmur,anemia,hematuria,positive rheumatoid factor,and enlarged liver and spleen.The most common complication is heart failure,followed by organ embolism and hepatic and renal insufficiency.Characteristics of pathogenic microorganisms:Blood culture were positive in 46(57.5%)of the 80 patients with infective endocarditis.Pathogenic bacteria mainly include gram-positive coccus,gram-negative bacillus and fungus.In gram-positive coccus,the highest positive rate was shown in aureus staphylococcus.Basic heart diseases:In this study,72 patients(90%)were complicated with basic heart diseases.The most commonly encountered heart diseases were heart valve disease,coronary heart disease and congenital heart disease.In this study,non-rheumatic valvular disease was the most common valvular disease,and the lesions of the valve were mainly aortic valve and mitral valve.Thirty percent of these patients had suffered heart surgery,including artificial valves,congenital heart disease,pacemaker implantation and percutaneous coronary stenting.Echocardiographic findings:62 patients with echocardiography showed valves or cardiac cavity excrescences,with a positive rate of about 77.5%.The vegetations distributed in the aortic valve,mitral valve,tricuspid valve,pulmonary valve,right atrium,and right ventricle.According to the results,the excrescences were mainly attached to the left cardiac system,while the proportion of the right cardiac system was lower.Besides,cardiac valve echocardiography manifestations mainly include:valve regurgitation,valve stenosis,valve leakage,valve perforation,aortic valve calcification,valve abscess.Results and outcome of internal and surgical treatment:54 of 80 patients with infective endocarditis received surgical treatment and 26 received conservative medical treatment.The main medical treatment is intravenous antibiotics.Surgical treatment mainly included valve replacement in 47 cases(86.4%),valve formation in 3 cases(5.6%),electrocauterization of perivalvular abscess in 1 case(1.8%),and removal of simple vegetations in 3 cases(5.6%).There was no significant difference in age,clinical manifestations,and complications of fever,heart murmur,liver,kidney,and brain diseases in the internal and surgical treatment group,but 5 patients in the internal treatment group developed septic shock and multi-organ dysfunction,which was also the main cause of 6 patients in the internal treatment group who had not recovered or died.Conclusion The results showed that adult patients with infective endocarditis were mainly young and middle-aged,and the proportion of male patients was significantly higher than that of female patients.Fever and heart murmur are the most common clinical manifestations of infective endocarditis.Valvular heart disease is the most common basic heart disease,especially the left heart system,and congenital heart disease accounted for a lower proportion.The pathogenic microorganisms were mainly gram-positive coccus,and staphylococcus aureus had the highest proportion,followed by streptococcus grass green.Ultrasonic examination exhibited a high positive rate in detecting cardiac excrescences,with the left cardiac system as the main attachment site.The most common complication was heart failure,followed by organ embolism and liver and kidney injury.Surgical treatment of infective endocarditis is effective,and the prognosis of patients is significantly better than that of conservative medical treatment.Therefore,patients who meet surgical conditions should be actively treated with surgical treatment.