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1、感染性心内膜炎InfectiveEndocarditisDefinitionandclassification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：nativevalveendocarditis人工瓣膜感染：prostheticvalveendocarditis(PVE)右心瓣膜感染性心内膜炎rightheartvalveendocarditis:drugabuse,AIDS,catheterizationEt
2、iologyandMechanism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EndocarditisHeartstructuralabnormalityEndocardialinjurythrombosisAdhesionofbacteriaDisturbanceofbloodflowMechanismvegetationSystematicembolism,abs
3、cessEndocarditisKidney,Liver,JointdiseasesImmunesystemactivationPathologyThrombusandbacteriaClinicalManefestation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：MurmurappearanceorchangeHeartfailureArrhythmia:heartblock,severe血管损害：SystematicembolismSkin:petechi
4、aeSpleen,kidney,limbs,Brain,Messentricembolism免疫反应表现：OftenseeninSIENocharacteristicsOslernode,TothClinicalManefestationEmboliclesionsonthefeetofapatientwithStaphylococcusaureusendocarditisSkinandNailLesionsinstaphylococcalendocarditis.Typicalsubungua
5、l("splinter")hemorrhageandnumerouspetechiaeontheskinoftheabdomenLabfindingsBloodculture:MostimportantdiagnosticmethodVeinbloodX3timesNegativedoesnotexcludethediagnosisGramstainedsmearfrombloodculturebottleshowingviridansstreptococcifromptwithnativeva
6、lveendocarditisEchocardiographyTTE:TEE:moreusefulVegetationAVorMVinsufficiencyAbsceseAortarootabscessinTEEstudyPerivalvarabscessofMVannulus,andperforationVegetationDiagnosisTheConceptionofIEFever>1weekinptswithstructuralheartdiseasesorheartoperationT
7、heappearanceorchangeofcardiacmurmurSystematicembolismwithnoobviouscauseHeartfailurewithnoobviouscauseManagementAntibiotics: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2.手术治疗没有办法之办法应掌握好指证：seeP315该开不开也不对Management3.对症治疗内科医生具备的常规知识Heartfailure
8、SystematicembolismArrhythmias:Arterialaneurysm:dependsManagement治愈标准症状改善体征：anemia,spleen,cardiacmurmurLab:anemia,Urineproteinbloodculture(-):1,2,6wManagementRecurrence:samebacteriaRepeatantibioticsPrevention预防性应用抗生素PrognosisMortality:AIE:20-50%SIE:20
