Infective endocarditis (IE) yog cov ntshav los ntawm cov nqaij hauv lub plawv uas tuaj yeem ua rau hnyav sai. Hmoov zoo, nws kuj tseem yog qhov xwm txheej tsis tshua muaj tshwm sim uas feem ntau tuaj yeem kho tau zoo thaum kuaj mob sai. IE feem ntau kuaj pom los ntawm kev soj ntsuam cov tsos mob (zoo li ua npaws), ntsuas kev pheej hmoo (xws li kev phais tsis ntev los no), thiab ua cov kab mob ntshav thiab echocardiograms.
Cov kauj ruam
Nqe lus nug 1 ntawm 9: Tus kab mob endocarditis sib kis (IE) yog dab tsi?
Kauj Ruam 1. IE yog kab mob microbial ntawm cov kab sab hauv ntawm lub plawv
IE tshwm sim thaum cov kab mob lossis cov kab mob kis tau los ntawm cov hlab ntshav thiab sau rau ntawm endocardium-lub plawv sab hauv sab hauv. Kev kis tus kab mob feem ntau kis los ntawm endocardium mus rau lub plawv li qub, cov leeg, thiab cov hlab ntshav.
- IE yog qhov tsis tshua muaj tshwm sim, nrog ib ncig ntawm 5-8 tus neeg rau 100, 000 tus neeg hauv ib xyoos hauv Asmeskas, tab sis nws kuj yog ib qho mob hnyav.
- IE tshwm sim los ntawm cov kab mob ntau dua li IE tshwm sim los ntawm cov kab mob hu ua fungi.
Nqe lus nug 2 ntawm 9: Qhov txawv ntawm qhov mob hnyav thiab mob ntev li cas?
Kauj Ruam 1. Lawv zoo ib yam, tab sis IE mob hnyav ua sai dua
IE tuaj yeem txhim kho sai heev lossis qeeb dua yam tsis muaj lus sib dhos lossis vim li cas. Mob hnyav (txhim kho sai thiab mob hnyav) IE tuaj yeem dhau los ua kev phom sij rau lub neej nyob rau ob peb hnub xwb. Ntev (txhim kho qeeb thiab tsis tu ncua) IE yuav siv sijhawm ntau lub lis piam lossis ntau lub hlis los tshwm, tab sis kuj tseem tuaj yeem ua rau hnyav heev.
Chronic IE tseem hu ua sub-acute IE
Nqe lus nug 3 ntawm 9: Dab tsi yog qhov ua rau IE feem ntau?
Kauj Ruam 1. Yam uas tso cov kab mob me me rau hauv cov ntshav zoo li kev phais thiab kis kab mob-tuaj yeem ua rau IE
Cov kab mob phem los yog cov hu ua fungi uas nkag mus rau hauv cov hlab ntshav nyob txhua qhov hauv lub cev yuav xaus rau hauv plawv, thiab tuaj yeem ua rau IE. Piv txwv li, kev phais mob uas tshwm sim nyob ze ntawm lub plawv zoo li kev cog lub tshuab ua kom lub zog tuaj yeem yog qhov ua rau. Uas tau hais tias, txhua yam los ntawm kev txiav hauv lub qhov ncauj kom hlawv ntawm ko taw tuaj yeem ua rau IE.
- Thaum IE tsis tshua muaj neeg pom, ib qho txheej txheem kho mob hnyav tuaj yeem ua rau nws. Lwm qhov ua rau muaj peev xwm suav nrog kev kho hniav tsis zoo, siv tshuaj txhaj tshuaj, rov qab mob ntawm daim tawv nqaij, thiab ntau yam kab mob sib kis, ntawm lwm qhov muaj peev xwm.
- Cov kab mob thiab/lossis kab mob hauv lub plawv tseem ua rau IE muaj feem ntau.
Nqe lus nug 4 ntawm 9: Leej twg thiaj yuav tsim tau IE?
Kauj Ruam 1. Txhua tus tuaj yeem tau txais IE, tab sis teeb meem plawv thiab lwm yam kev mob nkeeg ua rau muaj kev pheej hmoo
IE txiav hla lub hnub nyoog, poj niam txiv neej, haiv neeg, haiv neeg, thiab lwm yam kab. Cov neeg uas tau yug los nrog mob plawv los ntawm lub hnub nyoog muaj kev pheej hmoo siab dua, tab sis tsis pom muaj caj ces predisposition rau IE tau pom. Yuav ua li cas thiaj tau txais IE feem ntau yog ua raws cov kev pheej hmoo xws li hauv qab no:
- Cov xwm txheej yav dhau los ntawm IE
- Cov kab mob thiab/lossis kab mob hauv lub plawv
- Cov txheej txheem kho mob
- Cov cuab yeej kho mob cog
- Qhov ncauj raug mob lossis kis mob
- Cov tawv nqaij raug mob lossis kis mob
- IV siv tshuaj
- Tsev kho mob ntev
Nqe lus nug 5 ntawm 9: Cov cim thiab tsos mob ntawm IE yog dab tsi?
Kauj Ruam 1. Ua npaws tsis tau piav qhia yog tus lej-ib qho ntawm ob qho tib si mob hnyav thiab mob IE
Acute IE feem ntau tshwm sim nrog kub taub hau sai ntawm 102 thiab 104 ° F (39 thiab 40 ° C), thaum mob IE feem ntau tshwm sim nrog ua npaws me ntsis hauv 99 txog 101 ° F (37 txog 38 ° C). Lwm cov tsos mob tuaj yeem suav nrog ib qho lossis tag nrho cov hauv qab no: qaug zog, nrawm lub plawv, ua daus no, tawm hws ntau, mob lub cev, hnoos tas mus li, txhais ceg lossis ko taw o, thiab ntshav tsis txaus.
Cov tsos mob ntawm IE ua piv txwv ntawm ntau lwm yam kev mob thiab tuaj yeem yooj yim tsis nco. Ib tus neeg twg uas muaj feem cuam tshuam rau IE-xws li kev phais mob tsis ntev los no, siv tshuaj IV, lossis kab mob hauv lub plawv-yuav tsum saib xyuas kom zoo ntxiv rau txhua yam tsos mob IE
Nqe lus nug 6 ntawm 9: Cov kws kho mob kuaj IE li cas?
Kauj Ruam 1. Echocardiograms thiab kev coj ntshav yog qhov tseem ceeb rau kev kuaj mob IE
Ib qho echocardiogram (ncha), uas siv lub suab nthwv dej los tsim cov duab ntawm lub plawv, yog siv los nrhiav "zaub" -bacterial lossis fungal growth-on the endocardium. Cov kab lis kev cai hauv ntshav, uas cov ntshav tau kos thiab kuaj rau cov kab mob me me, tau siv los txheeb xyuas cov kab mob lossis kab mob hu ua tam sim no hauv cov ntshav.
- Ib qho transthoracic echocardiogram (TTE) feem ntau siv thawj zaug los saib xyuas cov nroj tsuag, tej zaum yuav ua raws los ntawm transesophageal echocardiogram (TEE) yog TTE cov txiaj ntsig tsis suav nrog.
- Hauv qee kis mob hnyav, IE tuaj yeem kuaj pom los ntawm cov xwm txheej txaus ntshai thiab cov tsos mob ib leeg kom txoj kev kho tuaj yeem pib tam sim.
Nqe lus nug 7 ntawm 9: Dab tsi yog "hloov kho Duke cov qauv" rau kev kuaj mob?
Kauj Ruam 1. Lawv yog cov txheej txheem tseem ceeb thiab me me uas siv los tshuaj xyuas IE
Raws li qhov hloov kho Duke nplai, muaj 2 yam tseem ceeb: 1) pov thawj ntawm cov zaub ntawm echocardiogram; 2) ib khub zoo, txuam ntshav kab lis kev cai. Kuj tseem muaj 5 qhov xwm txheej me: 1) ua npaws; 2) qhov muaj feem pheej hmoo ua ntej (s) rau IE; 3-5) vascular, kev tiv thaiv kab mob, thiab microbiologic tshwm sim uas tsis tuaj yeem piav qhia lwm yam. Yog tias tus neeg mob muaj 2 tus qauv tseem ceeb, 1 qhov tseem ceeb thiab 3 yam tsis tseem ceeb, lossis 5 qhov kev ntsuas me me, lawv yuav tsum kuaj mob nrog IE.
Thaum hloov kho Duke cov txheej txheem yog "txheej txheem kub" tam sim no rau kev kuaj mob IE, lawv tsis dag. Raws li lub npe qhia, lawv tau hloov kho ua ntej thiab zoo li yuav hloov pauv ntau ntxiv rau yav tom ntej
Nqe lus nug 8 ntawm 9: IE raug kho li cas?
Kauj Ruam 1. Tshuaj tua kab mob yog kev kho ua ntej, tom qab phais yog tias tsim nyog
Yog tias kev kho mob pib ua ntej pom cov kab mob tshwj xeeb lossis kab mob hu ua fungi, cov kws kho mob feem ntau sau tshuaj tua kab mob zoo li nafcillin lossis vancomycin thiab gentamicin-uas yog lub hom phiaj feem ntau ua rau IE. Txawm li cas los xij, nws zoo dua tshwj xeeb rau lub hom phiaj tshwj xeeb rau cov kab mob lossis cov fungi nrog tshuaj tua kab mob thaum twg los xij. Nyob ib ncig ntawm 25-50% ntawm IE rooj plaub kuj yuav tsum tau phais kom tshem tawm cov ntaub so ntswg uas muaj kab mob thiab ua txhua yam tsim nyog kho lub qhov txhab.
Yog tias IE yog tshwm sim los ntawm MRSA, piv txwv li, kev kho tshuaj tua kab mob yuav suav nrog noj vancomycin li 6 lub lis piam. Yog tias nws yog MSSA hloov, 6 lub lis piam ntawm nafcillin lossis oxacillin thiab 3-5 hnub ntawm gentamicin yuav siv tau
Nqe lus nug 9 ntawm 9: Puas yog IE feem ntau kho tau?
Kauj Ruam 1. Feem ntau tuaj yeem kho tau, tab sis cov neeg tuag tseem tsawg kawg 20%
Thaum qhov kev kuaj mob thiab kho IE tau txhim kho txhua lub sijhawm, nws tseem yog qhov xwm txheej txaus ntshai nrog qhov ua rau neeg tuag taus-siab. Hauv qee kis, IE tuaj yeem kuaj pom lig dhau, cov kab mob lossis cov fungi tuaj yeem tiv thaiv cov tshuaj tua kab mob uas tau muab, lossis ib qho kab mob hauv lub plawv uas twb muaj lawm tuaj yeem ua rau muaj kev puas tsuaj ntxiv los ntawm IE hnyav heev rau kev rov zoo. Kev kuaj mob ntxov thiab tsom mus rau kev kho mob yog qhov tseem ceeb hauv kev txo qis kev tuag.
