肺炎支原体感染引起儿童心脏栓塞10例临床分析

Clinical analysis of 10 children with cardiac thrombus associated with Mycoplasma pneumoniae infection

目的探讨肺炎支原体感染引起儿童心脏栓塞的特点、治疗及预防措施,以提高临床医师对该病的认识。方法回顾性分析2015年11月至2020年1月济南市儿童医院呼吸介入科收治的10例肺炎支原体感染引起心脏栓塞患儿的临床资料,包括病例资料、实验室检查结果、影像资料及随访结果等。结果10例患儿男女比例7∶3,中位年龄6.5岁,发热时间均超过1周,9例患儿血浆D-二聚体(D-D)明显升高,6例患儿C反应蛋白(CRP)升高。经抗感染治疗后患儿肺炎肺不张均较前吸收好转。1例患儿手术后栓子消失,其余9例予抗凝治疗,其中单纯肝素抗凝治疗7例,2例于住院期间心脏栓子消失,1例院外口服2周双嘧达莫后栓子消失,另4例住院期间经单纯肝素抗凝治疗效果欠佳,出院后2例分别于出院后4个月、5个月复查栓子消失,2例因个人原因未复查;2例经肝素抗凝无效后改为低分子肝素+华法林抗凝的患儿于出院2个月后复查栓子消失。随访10例患儿,均无气促、胸痛等症状。结论发热时间长,CRP及D-D明显升高的患儿更易形成血栓,血栓形成后抗凝治疗有效,抗凝治疗无效或担心栓子脱落引起并发症的患儿可行外科手术取栓治疗。

Objective To explore the case characteristics,treatment and prevention measures of cardiac thrombus in children caused by Mycoplasma pneumoniae infection,so as to improve the clinicians′understanding of the disease.Methods The clinical data of 10 children with cardiac thrombus caused by Mycoplasma pneumoniae infection treated in Department of Respiratory Intervention,Jinan Children′s Hospital from November 2015 to January 2020 were retrospectively analyzed,including datum of cases,laboratory results,imaging data and follow-up results.Results A total of 10 children(7 males and 3 females)were included with the median age of 6.5 years old,and all had fever for more than 1 week.The plasma D-dimer(D-D)of 9 children was significantly increased,and the C-reactive protein(CRP)of 6 children was increased.After anti-infection treatment,the absorption of pneumonia with atelectasis was better than before.The embolus disappeared after operation in 1 case,and the remaining 9 cases received anticoagulant therapy,among which 7 cases received Heparin anticoagulant therapy alone:cardiac embolus disappeared during hospitalization in 2 cases,disappeared after 2 weeks of oral administration of Dipyridamole outside the hospital in 1 case,and the other 4 cases received Heparin anticoagulant therapy alone during hospitalization with poor effect,embolus disappeared in 2 cases 4 and 5 months after discharge respectively,and 2 cases were not reexamined due to personal reasons;the embolus disappeared 2 months after discharge in 2 cases who were changed to low-molecular weight Heparin+Warfarin anticoagulant therapy after failing to respond to Heparin anticoagulant therapy.All the 10 cases showed no symptoms of tachypnea or chest pain during telephone follow-up.Conclusions Children with long fever time and significantly elevated CRP and D-D are more likely to form thrombus.Anticoagulant therapy is effective after thrombosis,and surgical thrombectomy can be performed in children who have failed to respond to anticoagulant therapy or worry about complications caused by dropped embolus.