感染性心内膜炎课件

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1、感染性心内膜炎InfectiveEndocarditis武汉大学人民医院心内科概述概念微生物感染赘生物形成受累部位瓣膜间隔缺损部位腱索心壁内膜分类急性（数天）亚急性（数周至数月）自体瓣膜人工瓣膜静脉药瘾者OutlinesConceptionInfectionofmicrobes,ecphymaformationSitesinvolvedValves,septaldefects,chordatendineaeCategorizationsAcute,subacuteAllovalves,prostheticvalve病因细菌感染为主急性金

2、黄色葡萄球菌亚急性草绿色链球菌菌谱复杂真菌衣原体少见静脉药物滥用者金黄色葡萄球菌50%人工瓣膜凝固酶阴性葡萄球菌金黄色葡萄球菌革兰氏阴性杆菌EtiologyBacterialinfectionAcute:StaphylococcusaureusSubacute:StreptococcusviridansandothersRarelycausedbyeumyceteorchlamydiainfectionIntravenousdrugabusers:halfwerecausedbystaphylococcusaureusProstheti

3、cvalvepatients:Staphylococcusaureus,Gram-Negativebacillus发病机制血流动力学因素亚急性多见于器质性心脏病赘生物位于血流从高压腔到低压腔形成湍流和射流的下游高速射流冲击心脏或大血管内膜处并致损伤感染性心内膜炎内面观—赘生物MR时二尖瓣心房面AR时主动脉瓣心室面PathogenesyAbnormalhaemodynamicsOrganicheartdiseaseHighspeedafflux发病机制典型的非细菌性血栓性心内膜炎非细菌性血栓性心内膜炎非细菌性血栓性心内膜炎内皮受损高凝状态

4、赘生物很少超过0.5cmPathogenesy典型的非细菌性血栓性心内膜炎非细菌性血栓性心内膜炎Non-bacterialembolicendocarditisEndothelialdamageHypercoagulabalestateEcphyma<0.5cm发病机制非细菌性血栓性心内膜炎非细菌性血栓性心内膜炎SLE患者扁平状赘生物附于瓣膜及腱索，心内膜急性风湿热疣状赘生物附于瓣膜闭合处边缘非细菌性血栓性心内膜炎Non-bacterialembolicendocarditisSLEpatientsAcuterheumaticfever

5、Pathogenesy发病机制短暂性菌血症皮肤粘膜内外科、牙科操作人工瓣膜置换术注射毒品细菌感染无菌性赘生物细菌数量毒力侵袭力粘附力急性感染性心内膜炎机制不清正常瓣膜金黄色葡萄球菌PathogenesyTransientbacteremiaSkin,mucosaoperationProstheticvalvereplacement,DruginjectionBacterialinfectedecphymaBacterialnumber,toxicity,invasiveness,adhersionAcuteendocarditisUnc

6、learmechanism,normalvalves,Staphylococcusaureus发病机制静脉内药物滥用者右心室入口—三尖瓣人工瓣膜术后第一年人工主动脉瓣人工二尖瓣机械瓣生物猪瓣PathogenesisIntravenousdrugabuserRightventricle—tricuspidProstheticvalveOneyearafteroperationAorticvalveprosthesis,mitralvalveprosthesisMechanicalprostheticvalve,biologicalvalv

7、e病理心内感染赘生物结节状菜花状息肉状感染性心内膜炎主动脉瓣上有一红棕色的赘生物PathologyEndocardiainfectionEcphymanodositycauliflowerpolyiformInfectiveendocarditisMarronecphymacanbefoundinaorticvalve病理心内感染瓣叶破损穿孔腱索断裂感染性心内膜炎不规则的红棕色赘生物位于主动脉瓣瓣尖并造成损害PathologyEndocardiainfectionValveleafledamagedRuptureofchordaeten

8、dinInfectiveendocarditisIrregularmarronecphymacanbefoundinaorticvalve病理感染性心内膜炎从二尖瓣扩散至室间隔及三尖瓣并形成瘘管局部扩散瓣环