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目的探讨儿童感染性心内膜炎(IE)的临床特点、治疗方法及转归。方法回顾分析中南大学湘雅二医院儿科1980—2004年确诊的174例IE患儿的临床特点。174例患儿中男94例,女80例,年龄3个月至14岁,病程3d至4个月。结果(1)99例IE发生在先天性心脏病的基础上,35例发生在风湿性心脏病的基础上,35例发生在无器质性心脏病基础上,4例于先天性心脏病手术后发生,1例发生在肥厚性心肌病的小儿。(2)临床主要表现:发热(150例,86·2%)、肝大(74例,42·5%)、脾大(55例,31·6%)、贫血(65例,37·4%)、血沉增快(68例,39·1%)、多发性脏器栓塞(34例,17·8%)。细菌培养76例(76/174)阳性,阳性率43·7%,其中55例为葡萄球菌。(3)受累瓣膜以二尖瓣赘生物最多见,占48·3%。(4)并发症以顽固性心衰为主(25·2%),其次为神经系统并发症(13·2%),瓣膜腱索断裂最少见(0·57%)。(5)由于IE临床表现很不典型,病例早期被误诊为流感、肺结核、急性风湿热、肾小球肾炎等10余种疾病。(6)治愈率为60·9%,其中单用抗生素治疗治愈76例(71·6%),抗感染治疗联合外科手术治愈30例(28·3%)。死亡28例(16·1%),脑栓塞及顽固性心衰是IE最常见的死亡原因。结论发生IE的基础心脏病中,先天性心脏病跃居首位,风湿性心脏病逐渐减少。血培养、超声心动图检查有助于IE的诊断。对于IE最重要的治疗措施是应用抗生素,若经内科治疗效果不满意应尽早考虑外科治疗。

Clinical analysis of 174 children with infectious endocarditis

??AbstractObjectiveTo research into the clinical characteristics,therapeutic approach and in children with infectious endocarditis. MethodsClinical data of 174 children patients with IE treated in Xiangya Second Hospital of Central South University from 1980 to 2004 were reretrospectively analyzed. Results1.There are 99 patients resulting from congenital cardiovascular diseases,35 patients from rheumatic heart disease,35 patients from heart diseases without parenchymal,4 patients after operation of congenital cardiovascular diseases and 1 patient from hypertrophic cardiomyopathy (HCM).2.Clinical manifestations were: fever(86%)??hepatomegaly(42??5%)??splenomegaly(31??6%)??anaemia(37??4%)??erythrosedimentation faster(39??1%) and multiple organ embolism(17??8%)and 76 patients?? germiculture was positive,the rate being 43??67%,and 55 patients resulted from staphylococci.3.The most concerned heart valve was diopathic mitral valve echocariogram witch,covering 48??3%.4.The most common complication of IE was intractable heart failure(25??2%),the second being nervous system complication(13??2%).5.Because the clinical manifestation of IE was not typical,the cases were often misdiagnosised as influenza,pneumonophthisis,acute rheumatic fever,glomerular nephritis and others.6.The cure rate of IE was 60??9%,among which,76 patients were cured simply by antibiotics (71??6%) and 30 patients were cured by anti??infection combining operation(28??3%);28 patients died.Cerebral embolism and intractable heart failure were common death causes in IE. ConclusionCongenital cardiovascular diseases is in the first place in the basic heart diseases,and rheumatic heart disease is decreasing gradually.Hemoculture and echocardiogram are helpful for the diagnosis of IE.The most important measure is antibiotics.The children patients should turn to surgical therapy if the medical curative effect isn t satisfactory.