小儿及少年感染性心内膜炎20例临床分析

Clinical analysis of infective endocarditis in 20 infancy and children

目的 :为少儿感染性心内膜炎 (IE)的诊治及预防寻找对策。方法 :对 2 0例少儿 IE的临床资料进行回顾性分析。结果 :IE2 0例中 ,非青紫型先天性心脏病 1 0例 ,均为室间隔缺损 (VSD) ,其中 5例合并主动脉瓣关闭不全 (AI) ;青紫型先天性心脏病 2例 ;风湿性心脏病 6例 ;心脏结构正常 2例。部分患者伴有明显的免疫功能紊乱。血培养阳性 1 0例。超声心动图检查发现瓣膜赘生物1 7例。治疗主要用青霉素等。死亡 5例。结论 :1心脏结构异常是 IE的主要基础病因 ;2先天性心脏病 VSD合并 AI、风湿性心脏病有二尖瓣脱垂和联合病变者为发生 IE的高危儿 ,对这些患儿应定期用抗生素积极预防 ;3超声心动图检查对 IE的诊断有重要价值。4对确诊或高度疑诊的 IE患儿 ,首先应内科治疗。

Objective:To seek strategy in the diagnosis, treatment and prevention of infective endocarditis (IE) in children. Method:Retrospective study of the clinical profiles of 20 children with IE. Result:20 cases of IE were composed of non cyanotic congenital heart disease 10 cases, cyanotic congenital heart disease 2 cases, rheumatic heart disease 6 cases and normal heart structure 2 cases. 10 cases of non cyanotic corgenital heart disease all had ventricular septal defect, half of which were complicated with aortic insufficiency (AI). There were apparent dysfunction of immune system in some patients. Blood culture with positive bacteria was found in 10 cases. The cardiac valve vegetation was detected by echocardiography in 17 cases. Penicillin was mainly used in the treatment. 5 cases died. Conclusion:①The abnormality of heart structure accounts for the main basic cause of IE. ②Antibiotics should be employed in order to prevent IE for the high risk patients, who have VSD plus AI, rhematic heart disease associated with mitral valve prolapse or combined valve di sease.③Echocardiography examination plays an important role in the diagnosis of IE.④In the confirmed or highly suspected case with IE, medicine should be first considered.