临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (2): 129-.doi: 10.3969/j.issn.1000-3606.2020.02.013

• 综合报道 • 上一篇    下一篇

先天性心脏病合并感染性心内膜炎42 例患儿超声分析

傅行鹏, 叶菁菁, 俞劲, 钱晶晶, 杨秀珍, 赵镭, 蒋国平   

  1. 浙江大学医学院附属儿童医院 国家儿童健康与疾病临床医学研究中心(浙江杭州 310052)
  • 发布日期:2020-02-20
  • 通讯作者: 叶菁菁 电子信箱:6195005@zju.edu.cn

Ultrasonographic diagnosis of 42 children with congenital heart disease complicated with infectious  endocarditis

 FU Xingpeng, YE Jingjing, YU Jin, QIAN Jingjing, YANG Xiuzhen, ZHAO Lei, JIANG Guoping   

  1. The Children's Hospital, Zhejiang University School of Medicine, Nationd Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang, China
  • Published:2020-02-20

摘要: 目的 评价超声心动图在诊断先天性心脏病(CHD)并发感染性心内膜炎(IE)中的价值。方法 回顾分析 2009年1月-2018年7月住院确诊CHD并发IE患儿的临床资料。结果 共42例CHD并发IE患儿,男20例、女22例;中 位年龄7岁1个月,其中学龄期儿童17例(40.5%),婴幼儿15例(35.7%)。术前27例,其中左向右高速分流型19例(70.4%); 术后15例。主要CHD类型为室间隔缺损(VSD)19例(45.2%)和复杂型CHD 10例(23.8%)。临床表现为发热37例(88.1%), 血培养阳性18例(43.9%)。 超声提示赘生物者共24例,术前16例(38.1%),术后8例(19.0%),另术前左心内膜增厚伴 回声增强1例,总阳性率59.5%。共发现赘生物38处,最常见位于瓣膜,22处。术前组11例行手术治疗,证实赘生物10例(另 1例术前检查赘生物持续缩小),术中发现瓣膜相关损伤5例(45.5%);余转院继续治疗3例,未愈2例。术后组在随访中 超声发现赘生物缩小或消失5例,转院治疗2例,未愈1例。超声发现合并心包积液3例,外周血管栓塞1例,均为术前。临 床赘生物患儿有效治疗16例,无赘生物患儿有效治疗15例,总有效治疗率73.8%。结论 超声对CHD并发IE患儿的诊断、 评估病情发展及预后方面可提供有效的依据。

关键词: 先天性心脏病; 感染性心内膜炎; 超声; 儿童

Abstract: Objective To evaluate the value of echocardiography in the diagnosis of congenital heart disease (CHD) complicated with infective endocarditis (IE). Methods The clinical data of CHD children with IE diagnosed in hospital from January 2009 to July 2018 were retrospectively analyzed. Results A total of 42 CHD children (20 males and 22 females) complicated with IE were enrolled. The median age of the children was 7 years and 1 month. Among them 17 (40.5%) were the school-age children, followed by 15 infants (35.7%). Twenty-seven (27) cases were preoperative, CHD including 19 cases of leftto-right high-speed shunt CHD (70.4%) and 15 cases of post-operative CHD. The main types of CHD were ventricular septal defect in 19 cases (45.2%) and complex CHD in 10 cases (23.8%). The clinical manifestations were fever in 37 cases (88.1%) and positive blood culture in 18 cases (43.9%). Ultrasound showed that there were 24 cases of vegetations, 16 cases (38.1%) before operation, 8 cases (19.0%) after operation, and 1 case of left endocardial thickening with echo enhancement before operation. The total positive rate was 59.5%. A total of 38 vegetations were found, most commonly located at the valve 22. In the preoperative group, 11 patients received surgical treatment, and 10 patients were confirmed with vegetations (another 1 patient was examined with vegetations continuously shrinking before surgery), 5 cases (45.5%) of valve-related injuries were found during operation. The remaining 3 cases were transferred to another hospital for further treatment, but 2 cases did not recover. In postoperative group, 5 cases were found to have reduced or disappeared vegetations, 2 cases were transferred to another hospital for further treatment and 1 case was not cured. Among the complications associated with ultrasound, 3 patients had pericardial effusion and 1 patient had peripheral vascular embolization, before operation. 16 children with clinical vegetation were treated effectively, and 15 children with no vegetation were treated effectively, the total effective treatment rate was 73.8%. Conclusion Ultrasound can provide an effective basis for the diagnosis of children with CHD complicated with IE. It can also provide great clinical value in assessing the development of the disease and prognosis.

Key words: congenital heart disease; infectious endocarditis; ultrasound; child