摘要
目的 探讨Duke标准对小儿感染性心内膜炎诊断的价值。方法 应用Duke标准对 5 0例临床诊断为感染性心内膜炎并经超声心动图检查的患儿及其中经手术证实为IE的患儿进行分组分析。结果 连续 2次或 2次以上血培养阳性并为相同致病菌的有 15例 (30 % ) ,1次血培养阳性 10例 (2 0 % ) ,39例 (78% )超声心动图检出赘生物 ,其中 2 6例的赘生物呈摆动状态。有 1例伴瓣膜穿孔 ,1例伴室间隔缺损补片脱落。按Duke标准 ,5 0例患儿中 2 1例 (4 2 % )被确诊为IE。其中 12例符合 2项主要指标 ,9例符合 1项主要和≥ 3项次要指标。 1例被排除IE。在 13例经手术证实的IE患儿中 ,按Duke标准确诊IE 5例 (38% ) ,8例为可能IE ,其中 6例符合 1项主要和 2项次要指标 ,2例符合 1项主要和 1项次要指标。手术证实为IE的 13例患儿中 ,10例血培养阴性 ,2例赘生物不摆动。结论 应用超声心动图检出赘生物对IE诊断有重要意义 ,在儿科病例中赘生物的确定不必限于摆动的团块。曾用抗生素治疗 ,有典型心内膜受累的超声心动图表现 ,另具备Duke标准中 2项临床次要指标的可确诊为IE 。
Objective To explore values of the Duke criteria for the diagnosis of pediatric infective endocarditis (IE). Methods Fifty children with the infective endocarditis detected by the echocardiography, 13 of them proved by the surgery, were classified by using the Duke criteria and analyzed.Results The same microorganism was detected in blood cultures two or more than two times in 15 patients (30%). Ten of 50 patients (20%) were revealed with one positive blood culture. Vegetations were detected by echocardiography in 39 patients (78%), 26 of them with oscillating vegetations, one patient with the valve perforation, one patient with new partial dehiscence of VSD′s patch. Forty five patients (90%) had predisposing heart conditions, 43 (86%) with the congenital heart disease. Fever was detected in 45 patients (86%). Thirtean patients complicated with the heart failure, 4 of them had no fever. Vascular phenomena including petechiae and major arterial emboli occurred in 11 patients (24%). Immunologic phenomena occurred in 5 patients, of whom 3 with glomerulonephritis and 2 with elevated rheumatoid factor. In 50 patients, a definite diagnosis of IE was made in 21 patients according to the Duke criteria, of whom 12 patients met two major criteria, 9 patients met one major and more than three minor criteria. One patient was ruled out from the diagnosis of IE. In 13 IE patients proved by surgery, 5 patients (38%) were diagnosed with definite IE, 8 patients were misclassified as possible IE, of whom 6 patients met one major and two minor criteria and 2 patients showed the association with one major and one minor criteria. The negative blood culture was reported in 10 of the 13 IE patients proved by surgery, and 2 of the 13 showed a non oscillating vegetation.Conclusion The detection of vegetation by using echocardiography is important and significant in the diagnosis of IE. The vegetation should not be defined to oscillating intracardiac mass in pediatric patient. In patient with prior antibiotic therapy, definite IE
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2001年第5期260-262,共3页
Chinese Journal of Pediatrics
关键词
感染性心内膜炎
儿童
诊断
Endocarditis, bacterial
Child
Diagnosis
