摘要
目的探讨感染性心内膜炎（IE）并发中枢神经系统疾病的诊治现状，分析其发病率、临床表现、诊断及治疗。方法对2例曾误诊的以中枢神经系统疾病首发的临床表现不典型的IE患者的临床资料进行回顾性分析。结果2例患者发病初期分别诊断为蛛网膜下腔出血及脑脓肿，入院后均经血培养和超声心动图检查确诊为感染性心内膜炎并发中枢神经系统疾病，分别给予大剂量、长疗程抗生素治疗。1例抗生素治疗后进行外科手术好转出院，另1例因长期误诊贻误病情预后不良。结论随着抗生素的广泛应用，IE的临床表现越来越复杂多变且不典型，以并发神经系统疾病为首发症状时易误诊、漏诊。加强对该病认识、仔细问诊和查体及发散诊断思维；多次查超声心动图及血培养有利于提高IE早期诊断率．及时制定有效的治疗方案．改善患者预后。
Objective To investigate the status of concurrent diagnosis and treatment of central nervous system diseases in patients with infective endocarditis （ IE）, to analyze the incidence, clinical manifestation, diagnosis and treatment. Methods The clinical data of two cases of neurological complications with IE which were misdiagnosed and had atypical clinical manifestations were retrospectively ana- lyzed. Results Two patients were diagnosed as subarachnoid hemorrhage and brain abscess respectively, they were diagnosed as IE combined with central nervous system diseases after blood culture and ech- ocardiography on admission and treated with high - dose, long course of antibiotic treatment. One case after surgical and antibiotic treatment were improved and discharged, however, the other one has a poor prognosis because of misdiagnosis. Conclusions With the widespread use of antibiotics, the clinical manifestations of IE are more complex and not typical, it is likely to misdiagnosis of central nervous sys- tem diseases in patients with IE. It is important to strengthen awareness of this disease, inquire and exam patients carefully, and divergent thinking when diagnosis. A number of inspections of echocardiography and blood cultures help to improve early diagnosis, timely develop effective treatment programs and ameliorate prognosis.
出处
《中国实用医刊》
2016年第23期4-7,共4页
Chinese Journal of Practical Medicine
关键词
心内膜炎
感染
中枢神经系统疾病
Endocarditis
Infection
Central nervous system diseases
