先天性心脏病合并感染性心内膜炎42例临床分析

Clinical analysis of infective endocarditis with congenital heart disease in forty-two cases

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.