摘要
目的:分析先天性心脏病(先心病)合并感染性心内膜炎患儿的特点,为提高本病诊断及治疗水平提供一定帮助。方法:收集2002年1月31日至2012年12月31日,我中心收治的先心病合并感染性心内膜炎病例共42例。将比例分为术前组、术后组,分析其临床表现、血培养、超声心动图及抗生素治疗及转归。结果:39例(92.9%)有发热表现,热程长短不一,热型多表现为不规则热,有贫血表现16例,有心功能不全8例。血培养阳性病例15例(35.7%),以葡萄球菌和链球菌为主,术后组以条件致病菌为主。34例(81.0%)经胸超声心动图发现赘生物,左心系统8例,右心系统24例,同时累及左-右心系统2例。术前组以青霉素、头孢哌酮钠舒巴坦钠、盐酸万古霉素应用最多;术后组应用最多的前3种分别为盐酸万古霉素、三代头孢及头孢哌酮钠舒巴坦钠。手术17例,自动出院11例,转院1例,余抗感染治疗好转出院。结论:先心病并感染性心内膜炎患者临床表现可不典型,但术前组和术后组在致病菌及抗生素应用方面有差别。抗生素的滥用可延误本病的诊治,应提高对本病的认识,及时诊断,规范治疗。
Objective:In favor of diagnosis and management,features of infective endocarditis with congenital heart disease are analyzed.Methods:Clinical data of infective endocarditis with congenital heart disease are collected and analyzed in 42 cases which were inpatients classfied as pre-operation and post-operation from 2002 to 2012,including manifestations,blood culture,echocardiogram,treatment and prognosis.Results:Fever is observed in 39 (92.9%) cases with an uncertain duration,most of which are in irregular style.Anemia is observed in 16 cases and cardiac insufficiency in 8 cases.Positive outcomes of blood culture are obtained in 35 (35.7%) cases,most of which are staphylococci and streptococci.conditioned pathogen is the majority bacteria in post-operation patients.Vegetation is detected by means of transthoracic echocardiography in 34 (81.0%) cases,with 8 in left-system,24 in right-system,and 2 in bi-systems.Penicillin,sulperazone and Vancomycin are used widely in pre-operation patients,and so do that in post-operation patient except Penicillin but cephalosporin.About the prognosis,17 patients performed operation,and 11 patients refused medical advice,1 transferred to another hospital,others checked out with improverd conditions.Conclusion:Clinical characteristics in patients of infective endocarditis with congenital heart disease may be atypical.Differences in pathogen and antibiotics are found within patients pre-operation and post-operation.Diagnose and cure would be delayed if antibiotics are abused.Something should be done to recognize and promptly diagnose this disease,followed by standard managements.
出处
《心肺血管病杂志》
CAS
2014年第2期227-231,共5页
Journal of Cardiovascular and Pulmonary Diseases
关键词
先天性心脏病
心内膜炎
细菌性
回顾性分析
Congenital heart disease
Endocarditis
Bacterial
Retrospective analysis