儿童感染性心内膜炎诊断与治疗

目的：探讨儿童感染性心内膜炎（IE）的临床特征，提高对儿童感染性心内膜炎的诊治水平。方法：回顾分析52例儿童感染性心内膜炎的基础病因、临床表现、并发症及治疗结果。结果：儿童感染性心内膜炎基础病因主要是先天性心脏病35例（67．3％），其次为风湿性心瓣膜病10例（19．2％），无基础心脏病7例（13．5％）。发热、贫血为儿童感染性心内膜炎常见临床表现。血培养阳性30例（57．7％），发现心内赘生物30例（57．7％）。外科手术治疗5例，术后患儿生活质量好。治愈35例（67．3％），自动出院3例，死亡14例（26．9％）。结论：先天性心脏病及风湿性心瓣膜病患儿出现不明原因长时间发热，无基础心脏病患儿发热、出现心脏杂音均应考虑感染性心内膜炎的可能，IE患儿经敏感、大剂量抗生索治疗后赘生物不消失、心瓣膜出现严重损害时应积极进行外科手术治疗。

Diagnosis and Treatment of Infective Endocarditis in Children

Objective:To improve the diagnosis and treatment of children with infective endocarditis by analysing their clinical features.Methods: The underlying disease,clinical features,complications and survivals of IE were analyzed retrospectively in 52 patients.Results: The underlying diseases included the congenital heart diseases in 35 patients(67.3%),rheumatic heart diseases in 10(19.2%) and no underlying diseases in 7(13.5%).Fever and anemia were common symptoms.Positive blood culture was found in 30 cases(57.7%).Endocardial vegetation was found in 30 cases(57.7%).Five patients were treated surgically.The mortality was 14 cases(26.9%).Conclusion: If children with the congenital or rheumatic diseases have long-time fever or children without underlying diseases develops cardiac murmur,they should be considered as patients with IE.In the children with IE sensitive and high dose of antibiotics should be used.If vegetation has not disappeared or cardiac valve develop a sever lesion,a active surgical treatment should be performed.