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目的:探讨小儿感染性心内膜炎(IE)的临床特点及血培养、超声心动图在IE中的诊断价值。方法:回顾分析吉林大学第一医院儿科1998年1月～2007年12月确诊的69例IE患儿的临床特点。结果:①69例IE患儿中,52例发生在先天性心脏病的基础上,5例发生在风湿性心脏病的基础上,3例发生在扩张性心肌病的基础上,1例发生在肥厚性心肌病的基础上,8例无基础心脏病。②临床主要表现:发热(67例,97.1%)、心功能不全(46例,66.7%)、镜下血尿(33例,47.8%)、脾肿大(26例,37.7%)。③血培养23例阳性,阳性率35.4%,致病微生物中以草绿色链球菌(9例)及β溶血性链球菌(5例)为最多见,条件致病菌5例。超声心动图检查64例患儿(92.7%)发现赘生物,阳性率仅次于发热表现。结论:小儿发生IE的基础心脏病中,先天性心脏病较多见,其次为风湿性心脏病。血培养、超声心动图有助于IE的诊断,且超声心动图更具有临床实用意义。
Objective: To investigate the clinical features of children with infective endocarditis (IE) and the value of blood culture and echocardiography in the diagnosis of IE. Methods: The clinical features of 69 children with IE diagnosed from January 1998 to December 2007 in the First Hospital of Jilin University were analyzed retrospectively. Results: ① Among the 69 cases of IE children, 52 cases occurred on the basis of congenital heart disease, 5 cases occurred on the basis of rheumatic heart disease, 3 cases occurred on the basis of dilated cardiomyopathy, and 1 case occurred on hypertrophy On the basis of sexual cardiomyopathy, 8 patients had no underlying heart disease. The main clinical manifestations were fever (67 cases, 97.1%), heart failure (46 cases, 66.7%), microscopic hematuria (33 cases, 47.8%) and splenomegaly (26 cases, 37.7%). (3) Blood culture was positive in 23 cases and the positive rate was 35.4%. Among the pathogenic microorganisms, Streptococcus viridans (9 cases) and β-hemolytic streptococcus (5 cases) were the most common and pathogenic bacteria were found in 5 cases. Echocardiography in 64 cases (92.7%) found neoplasms, the positive rate second only to fever performance. Conclusion: Among the basic heart diseases in children with IE, congenital heart disease is more common, followed by rheumatic heart disease. Blood culture, echocardiography contribute to the diagnosis of IE, and echocardiography more practical clinical significance.