小儿感染性心内膜炎69例临床分析及超声心动图的临床应用价值

Clinical analysis of 69 cases for infective endocarditis in children and the diagnostic value of echocardiography

目的:探讨小儿感染性心内膜炎(IE)的临床特点及血培养、超声心动图在IE中的诊断价值。方法:回顾分析吉林大学第一医院儿科1998年1月～2007年12月确诊的69例IE患儿的临床特点。结果:①69例IE患儿中,52例发生在先天性心脏病的基础上,5例发生在风湿性心脏病的基础上,3例发生在扩张性心肌病的基础上,1例发生在肥厚性心肌病的基础上,8例无基础心脏病。②临床主要表现:发热(67例,97.1%)、心功能不全(46例,66.7%)、镜下血尿(33例,47.8%)、脾肿大(26例,37.7%)。③血培养23例阳性,阳性率35.4%,致病微生物中以草绿色链球菌(9例)及β溶血性链球菌(5例)为最多见,条件致病菌5例。超声心动图检查64例患儿(92.7%)发现赘生物,阳性率仅次于发热表现。结论:小儿发生IE的基础心脏病中,先天性心脏病较多见,其次为风湿性心脏病。血培养、超声心动图有助于IE的诊断,且超声心动图更具有临床实用意义。

Objective： To investigate the clinical characteristics of infective endocarditis （IE） in children and the diagnostic value of blood culture and echocardiography on IE. Methods： The clinical features of 69 IE children patients who were treated in this hospital from January 1998 to December 2007 were retrospectively analyzed. Results： （1）There were 52 patients resulting from congenital cardiovascular diseases, 5 patients from rheumatic heart diseases, 3 patients from dilated cardiomyopathy, 1 patient from hypertrophic cardiomyopathy and 8 patients without underlying diseases. （2）Clinical manifestations were： fever （67 cases, 97. 1% ）, cardiac insufficiency （46 cases, 66. 7% ）, microscopic hematuria （33 cases, 47. 8% ） and splenomegaly （26 cases, 37. 7% ）.. （3）Positive blood culture was found in 23 cases （35. 4% ）. Streptococcus viridaus （9 cases） and beta -hemolytic streptococcus （5 cases） were the most common in pathogenic micro- organism, and there were 5 cases caused by opportunistic pathogen. Vegetation was found during echecardiography in 64 cases （92. 7% ）, and the positive rate was second only to the fever. Conclusion： Congenital cardiovascular disease is the most common in the basic heart diseases that cause IE, and rheumatic heart disease takes second place. Blood culture and echocardiography are helpful for the diagnosis of IE, and echocardiography has more practical significance in clinical diagnosis.