摘要目的 提高对感染性心内膜炎合并脓毒性肺栓塞的认识.方法 患者男,37岁,因“皮肤烧伤49 d,发热30 d,伴咳嗽、咳痰咯血18 d”于2015年9月7日入院,结合临床资料进行文献复习.以“burn”和“Infective Endocarditis"为英文检索词,“烧伤”和“心内膜炎”为中文检索词,分别在Pubmed、CNKI和万方数据库检索,检索时间截止至2016年5月,共检索到英文文献36篇,阅读后保留与烧伤和心内膜炎相关文献14篇,其中论著4篇,个案报道10篇;中文文献66篇,阅读后去除重复、会议论文汇编等,保留与烧伤和心内膜炎相关文献12篇,其中论著1篇,个案报道11篇.结果 本例患者临床表现为血培养多次耐甲氧西林葡萄球菌,超声心动图发现三尖瓣赘生物,胸部CT发现双肺楔形多发斑片渗出,确诊为急性细菌性心内膜炎合并脓毒性肺栓塞.共检索到26篇相关文献134例烧伤合并心内膜炎患者,其中感染性心内膜炎97例,合并脓毒性肺栓塞患者1例.共120例患者死亡,12例存活,2例预后不详,总病死率89.6％ (120/134).结论 烧伤合并感染性心内膜炎病死率高,当出现双肺多发斑片渗出时应考虑脓毒性肺栓塞的可能.药物联合及延长抗感染疗程可增加治疗成功率和降低复发风险.

abstractsObjective To improve the clinical recognition of infective endocarditis (IE) and septic pulmonary embolism (SPE) in patients with extensive burns.Methods A case of large area burn complicated with IE and SPE confirmed by blood cultures and echocardiography was described.A literature review was performed with "burn" and "infective endocarditis" as the Chinese key words in Wanfang database;with "burn" and "infective endocarditis" as Mesh terms in PubMed.Results The patient was a 37-year-old male with large area burn,who presented with fever and hemoptysis.Blood cultures were positive for methicillin resistant Staphylococcus aureus (MRSA).Echocardiography disclosed vegetations located in the tricuspid valve.Multiple wedge-shaped lesions were found on chest CT.From January 1978 to December 2015,26 related articles were retrieved and 134 burned patients complicated with endocarditis were reported,of which,97 cases were IE and 1 case with SPE.Of the 134 cases,120 cases were dead,12 cases cured and 2 cases unknown.The mortality was 89.6％.Conclusions There was a high mortality of burned patients complicated with IE.SPE should be considered for patients with multiple peripheral nodules in both lungs and a positive blood culture.Combination and prolonged anti-infective therapy may increase the treatment success and reduce the risk of recurrence.