儿童感染性心内膜炎的诊疗进展

Progress of Diagnosis and Treatment of Infective Endocarditis in Children

感染性心内膜炎(Infective endocarditis, IE)是指心内膜的感染性炎症,是一种少见但病死率较高的疾病。发热是本病最主要的临床表现,儿童IE最常见的危险因素是先天性心脏病及心脏操作,但近年来心脏结构正常的IE患者比例较前有所升高。IE的病原组成中以革兰阳性球菌占绝对优势,最常见的是葡萄球菌及草绿色链球菌。改良Duke标准是诊断IE的金标准,新的检查手段的应用进一步提高了诊断敏感性及准确性。早期手术的安全性和有效性受到肯定。IE的预防策略是针对高危患者进行抗生素预防,具体方案以及预防效果待进一步验证。

Infective endocarditis (IE) is an infectious inflammation of the endocardium and is a rare but highly morbid disease with a high mortality rate. Fever is the predominant clinical manifestation of the disease. The most common risk factors in pediatric patients are congenital heart disease and cardi-ac manipulation. Patients with IE with previously normal cardiac structures have increased in re-cent years. The dominant pathogen of IE is gram-positive cocci, the most common of which are Staphylococcus aureus and Streptococcus viridans. The gold standard for the diagnosis of IE is the modified Duke’s criteria, which based on clinical manifestations and laboratory tests. In recent years, the applications of new methods also helped a lot in the early diagnosis and treatment of IE. The safety and efficacy of early surgery have been confirmed. At present, the prevention strategy of IE is antibiotic prophylaxis that only for high-risk patients, and the specific plan and the effect of prevention are still debatable and validated.