小儿感染性心内膜炎临床特点的探讨

Clinical Characteristic of Infective Endocarditis in Children

目的:探讨小儿感染性心内膜炎(IE)的临床特点。方法:对该院近12年来收治的23例8个月-15岁的IE患儿进行回顾性分析。结果:23例IE患儿的基础病包括先天性心脏病14例(60.87％),后天性心脏病3例(13.04％),其它疾病6例(26.09％)。持续或反复发热(100％)、脾脏肿大(52.17％)、皮肤瘀点(47.83％)仍然是IE主要表现,栓塞(17.39％)较前减少,但并发心力衰竭较前增多(43.48％)。血培养阳性13例(56.52％),其中金黄色葡萄球菌占46.15％,草绿色链球菌占30.77％,表皮葡萄球菌占23.08％。超声心动图发现赘生物13例(56.52％)。23例IE患儿治愈16例(69.57％),死亡6例(26.09％)。结论:IE发生在先天性心脏病者仍居首位,临床表现多样化,致病菌中金黄色葡萄球菌仍占首位。超声心动图在诊断中有重要价值。预后与感染的细菌种类和毒力、以及并发症等有关。

Objective: To study the clinical characteristic of infective endocarditis (IE) in children. Methods: 23 cases of IE hospitalized from 1991 to 2002, ages from 8 months to 15 years, were analyzed retrospectively. Results: The underlying diseases of 23 cases consisted of 14 congenital heart diseases (60.87%), 3 acquired heart diseases (13.04%) and 6 other diseases (26.09%). Fever lasted or time and again (100%), splenomegaly (52.17%) and petechia or ecchymosis (47.83%) were still the main clinical manifestations. Arterial embolism (17.39%) decreased and heart failure (43.48%) increased. 13 cases of blood culture were positive (56.52%). In which staphylococcus aureus account for 46.15%, streptococcus viridans account for 30.77%, epidermal staphylococcus account for 23.08%. Vegetation was found in 13 cases(56.52%) by ultrasound echocardiography. The recovery rate was 69.57% (16 cases) and the mortality was 26.09% (6 cases). Conclusions: Congenital heart disease is still the most common underlying diseases of IE. The clinical characteristic of IE is changeful. Staphylococcus aureus is the most common causative pathogen. Ultrasound echocardiography is of great value in the diagnosis of IE. Its outcome is determined by the causative pathogen and the complications.