2019 年第 3 期 第 14 卷

起搏器相关右心感染性心内膜炎的临床特点分析

Clinical characteristics of right-side infective endocarditis associated with cardiac pacemaker

作者：那润萍张京梅田轶伦王龙

英文作者：

单位：100029首都医科大学附属北京安贞医院急诊危重症中心（那润萍），心内科十五病房（张京梅），心内科三十五病房（田轶伦）；100044北京大学人民医院心脏中心（王龙）

英文单位：

关键词：感染性心内膜炎；心脏起搏器；电极导线拔除术

英文关键词：

• 摘要：

• 【摘要】目的    探讨心脏起搏器相关右心感染性心内膜炎的临床特点。方法    回顾性分析2009年1月至2015年8月首都医科大学附属北京安贞医院和北京大学人民医院收治的13例起搏器相关右心感染性心内膜炎患者的临床资料。依据装置置入或末次更换距发生感染性心内膜炎的时间，将患者分为早期组(＜1年，7例)和晚期组(≥1年，6例)，比较2组患者临床特征、治疗及转归的差异。结果    13例患者中出现全身症状者占92.3%（12/13），出现局部症状者占38.5%（5/13），心脏杂音占23.1%（2/13）。血培养阳性者占76.9%（10/13），葡萄球菌占30.8%（4/13）。经胸超声心动图和/或经食管超声心动图检查均发现赘生物，赘生物大小为（14±8）mm。早期组和晚期组性别、年龄、起搏器置入次数、易感因素、临床症状及体征、实验室检查结果、血培养阳性率、赘生物大小比较差异均无统计学意义（均P＞0.05）。所有患者均完全清除原有装置。经静脉途径拔除电极导线的6例患者赘生物平均大小为（15±8）mm，经外科开胸拔除的7例患者赘生物平均大小为（14±8）mm，差异无统计学意义（P＝0.860）。所有患者均痊愈出院，至少随访36个月，未发现起搏器相关感染、死亡等不良事件。结论    葡萄球菌是起搏器相关右心感染性心内膜炎的常见致病菌。电极导线拔除术是安全有效的治疗方法。

• 【Abstract】Objective    To identify the clinical features of right-side infective endocarditis associated with pacemaker. Methods    A retrospective analysis was undertaken in 13 patients diagnosed of right-side infective endocarditis associated with pacemaker who were admitted to Beijing Anzhen Hospital, Capital Medical University and Peking University People′s Hospital between January 2009 and August 2015. According to the duration between onset and pacemaker implantation, the patients were divided into early group(＜1 year, n＝7) and late group(≥1 year, n＝6). Clinical features, therapeutic choice and prognosis were analyzed. Results    Systemic symptoms occurred in 92.3%（12/13） and local symptoms occurred in 38.5%（5/13） of the patients. Cardiac murmurs were found in 23.1%（2/13）. Positive blood culture was obtained in 76.9%（10/13）and staphylococcal accounted for 30.8%(4/13). Transthoracic/transoesophageal echocardiography demonstrated vegetations in all patients and the mean size of vegetations was （14±8）mm. There was no significant difference of gender, age, times of pacemaker implantation, predisposing factors, clinical symptoms and signs, laboratory results, blood culture positive rate and size of vegetations between the early group and late group（all P＞0.05）. Two techniques were used for cardiac device removal: transvenous removal（n＝6） and surgical removal with extracorporeal circulation（n＝7）; the mean size of vegetations showed no significant difference between transvenous and surgical removal［（15±8）mm vs （14±8）mm］(P＝0.860). All patients were cured. No death or pacemaker-related infection happened during the follow-up of at least 36 months. Conclusions    Staphylococcal is the main pathogenic bacteria of right-side infective endocarditis associated with pacemaker. Transvenous or surgical lead extraction is safe and effective.