Duck标准对感染性心内膜炎的诊断和治疗价值

Diagnosis and Treatment Value of Duck Criterien on Infective Endocarditis Judged in Children

目的探讨修改后Duck标准对儿童感染性心内膜炎(IE)的诊断和治疗价值。方法将22年来我院收治的73例先天性心脏病(先心病)并IE患儿,按照Duck标准作回顾性分析。结果确诊IE 37例(51%),其中16例(43%)外科手术时行病理活检形态学诊断,8例(22%)符合2项主要临床诊断标准,13例(35%)符合1项主要及≥3项次要指标。可能为IE 36例(49%)。抗生素治愈45例(62%);药物不能控制感染,发现有赘生物,手术清除及心脏畸形矫治16例(21%)。死亡12例(17%),其中1例术后死亡。结论IE仍是先心病严重的并发症,Duck标准临床诊断应用相对过严,特异性较高;但当赘生物形成尚未达到一定程度时,修改后Duck标准不能早期诊断。外科手术疗效满意,内外科联合治疗能有效降低死亡率。

Objective In order to explore practical values of the revised Duck criteria for diagnosis and treatment of pediatric infective endocarditis （IE）. Methods Seventy - three children＇s cases diagnosed and treatmented as IE complicated with congenital heart defects in the past 22 years were collected to make retrospective analysis according to the Duck criteria. Results In 73 patients, a definite diagnosis of 1E was made in 37 patients（51%）,16（43%） of which proved by the pathologic lesions during the operations. Eight patients（22%） met two major criteria, 13 patients（35% ） met one major and more than 3 minor, criteria. 36 patients（49% ） were diagnosed as possible IE. Forty - five patients（62% ） were cured using antibiotic therapy. Sixteen cases（21% ） were failure in antibiotic treatment,of whom 16 patients were operated by cutting off the detection of vegetation and repairing the heart malformation. Tweleve cases （ 17% ） were died, one of which was died after the operation. Conclusions IE is still a significant complication of congenital heart disease. Duck criteria is relative rigid in sensitivity, but it is high in specificity. When the vegetation isn＇t large enough in shape, revised Duck criteria is difficult to diagnose. The surgery treatment is optimistic. To combine the medicine with surgery can contributed to decrease mortality rate.