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題 名 | 院內感染性心內膜炎:三病例報告=Nosocomial Infective Endocarditis: Report of Three Cases |
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作 者 | 陳昶華; 劉尊榮; 黃美麗; 廖淑真; 林麗珍; 楊祖光; | 書刊名 | 院內感染控制雜誌 |
卷 期 | 9:6 1999.12[民88.12] |
頁 次 | 頁323-328 |
分類號 | 415.3166 |
關鍵詞 | 院內感染; 感染性心內膜炎; Nosocomial infection; Infective endocarditis; |
語 文 | 中文(Chinese) |
中文摘要 | 近年來由於院內感染性心內膜炎個案逐漸出現,而且死亡率偏高。為了要瞭解院內感染性心內膜炎的狀況,因此收集彰化某教學醫院,近十年內所發現的感染性心內膜炎個案,作一個回溯性分析。自民國78年1月到民國87年11月所診斷的感染性心內膜炎個案共計61例,其中院內感染性心內膜炎個案共計三例。佔本院感染性心內膜炎4.9%(3/61)。這三個院內感染性心內模炎病人的年齡均超過60歲(平均67歲),比起本院時區感染性心內膜炎病人年齡較大(平均41歲)。這三侗病人均為女性。感染個案的潛在疾病,有兩例是冠狀動脈血管疾病,一例是尿毒症病患。臨床症狀則以發燒、畏寒、休克等菌血症症狀為主。經由心臟超音波診斷,這三個病人侵犯的心臟瓣膜分別為主動脈瓣一例,二尖瓣一例,三尖瓣一例,致病茵種有綠膿桿菌(Pseudomonasaeruginosa)兩例,靈桿菌(Serratiamarcescens)一例。這三個感染個案均住過加護病房。感染來源,據推測有兩例可能來自血管內導管(intravascularcatheter),另一例可能來自腹膜透析導管。這三個病人均接受廣效性抗生素治療,其中一例接受心臟瓣膜置換術。這三個感染個案有一例死亡,整體死亡率為33%(1/3)。以上分析研究顯示,院內感染性心內膜炎感染個案以老年人為主,其成因往往由血管內導管,或腹摸透析導管所引起的;因此希望能經由加強血管內導管與腹膜透析導管的標準操作與照顧,以預防院內感染性心內膜炎的發生。 |
英文摘要 | Three cases of nosocomial infective endocarditis were identified between January 1. 1989 and November 30. 1998 at Changhua Christian Hospital in Taiwan. During the same period of time there were a total of 61 cases of patients with the diagnosis, thus the rate of noso-comial infection was 4.9%. The ages of the three, all female, were beyond 60 years (average 67), higher than that of the community-acquired cases (average 41 years). Two of them had coronary artery-diseases and one had uremia. Clinically, they presented with fever, chills, shock and septicemia. The valves involved included aortic. mitral and tricuspid, respectively, for each. Pseudomonas aeruginosa was the pathogen in two cases and Serrtia marcescens in one. They had been in the intensive care unit and received broad spectrum antibiotic coverage; one had cardiac valve replacement. The source of infection was believed to be the intravascular catheter in two cases and peritoneal dialysis catheter in one. One patient died. Strict adherence to the aseptic techniques in all procedures is still the best way to prevent the occurrence of the nosocomial infective endocarditis. |
本系統中英文摘要資訊取自各篇刊載內容。