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目的:探讨感染性心内膜炎发生心脏传导阻滞的类型、原因及其危险因素。方法:检索我院1996-07至2006-06期间治疗的感染性心内膜炎381例。回顾性分析感染性心内膜炎发生心脏传导阻滞的类型和原因;并根据是否发生心脏传导阻滞将感染性心内膜炎病人分为心脏传导阻滞组(n=25)和无心脏传导阻滞组(n=356),探讨感染性心内膜炎发生心脏传导阻滞的危险因素。结果:感染性心内膜炎心脏传导阻滞发生率6.6%,其中房室传导阻滞52.0%,室内传导阻滞48.0%。未发现窦房传导阻滞和房内传导阻滞。累及主动脉瓣的感染性心内膜炎可发生多种类型的心脏传导阻滞;累及主动脉瓣的感染性心内膜炎、人工瓣膜感染性心内膜炎、肠球菌或表皮葡萄球菌感染性心内膜炎是发生心脏传导阻滞的危险因素(P<0.05);伴瓣周脓肿的主动脉瓣感染性心内膜炎是发生心脏传导阻滞的高危因素(P<0.001)。感染性心内膜炎发生心脏传导阻滞以房室传导阻滞中的Ⅰ度房室传导阻滞和室内传导阻滞中的右束支传导阻滞最常见。结论:感染性心内膜炎发生心脏传导阻滞的类型与感染部位相关,伴瓣周脓肿的主动脉瓣感染性心内膜炎是发生心脏传导阻滞的高危因素。
Objective: To investigate the types, causes and risk factors of heart block in infective endocarditis. Methods: 381 cases of infective endocarditis treated in our hospital from 1996 to 2006-06 were searched. The types and causes of heart block in infective endocarditis were retrospectively analyzed. Patients with infective endocarditis were divided into heart block (n = 25) and no heart according to whether there was heart block Block group (n = 356) to investigate the risk factors for heart block in infective endocarditis. Results: The incidence of heart block in infective endocarditis was 6.6%, of which 52.0% were atrioventricular block and 48.0% were indoors. No sinoatrial block and in-room conduction block were found. Various types of heart block can occur with infective endocarditis involving the aortic valve; infective endocarditis, prosthetic valve infective endocarditis, enterococcal or staphylococcal infections involving the aortic valve Endocarditis was a risk factor for heart block (P <0.05). Aortic valve infective endocarditis with paravalvular abscess was a high risk factor for heart block (P <0.001). Cardiac conduction block in infective endocarditis is most common with first degree atrioventricular block in atrioventricular block and right bundle branch block in intraventricular conduction block. CONCLUSION: The type of heart block in infective endocarditis is related to the site of infection. Aortic valve infective endocarditis with paravalvular abscess is a risk factor for heart block.