摘要
目的分析儿童感染性心内膜炎临床特点变化及病原菌的变迁，为临床诊治提供进一步指导。方法回顾分析10年中我院73例14岁以下儿童感染性心内膜炎患儿外科手术的临床资料。并将1995年1月-1999年12月的32例（Ⅰ组）与2000年1月-2004年12月的41例（Ⅱ组）做统计学分析对比，比较两组病例临床特点的变化及病原菌的变迁。结果73例患儿占同期同年龄组住院患儿总数的7．3％（73／998），Ⅱ组的比例（41／671，6．1％）低于Ⅰ组（32／327，9．8％，P〈0．05）。66例有基础心脏病，其中室间隔缺损（VSD）47例，动脉导管未闭（PDA）15例，其他4例。心脏赘生物的检出率，Ⅱ组的比例（27／41，65．9％）高于Ⅰ组（15／32，46．9％，P〈0．01）。59例血细菌培养阳性，14例血细菌培养阴性。总的细菌培养阳性率为73．9％（54／73），Ⅰ组为96．88％（31／32），Ⅱ组为68．29％（28／41）。心脏赘生物的检出率增高，由Ⅰ组的46．9％（15／32）增高为Ⅱ组为65．9％（27／41）。儿童IE的病原菌菌谱发生明显变化，革兰阳性球菌的阳性检出率明显减少，而革兰阴性杆菌的检出率明显增加。结论外科治疗的儿童感染性心内膜炎临床特点发生一定变化，血培养的阳性率降低，而心脏赘生物的检出率增高。儿童IE的病原菌菌谱中革兰阴性杆菌所占比例有明显的增高。
Objective To analyze the patterns of clinical characteristics and pathogens of pediatric infective endocarditis （IE）. Methods A retrospective study of 73 IE cases under 14 years old during the past 10 years was conducted. These patients were divided into two groups according to their date of admission. Group Ⅰ included 32 patients admitted from January 1995 to December 1999, and group Ⅱincluded 41 cases admitted from January 2000 to December 2004. Results Seventy-three IE patients accounted for 7. 3%（73/998） of all the hospitalized surgical patients, the proportion in group Ⅱ was lower than that in group Ⅰ （6. 1% vs 9. 8%, P〈0. 05）. Among 73 cases, 66 had basic heart diseases. Fifty-nine cases had positive blood culture and the total positive blood culture rate was 80. 82% （59/73）, significantly decreased from 96. 88% （31/32） in group Ⅰ to 68. 29% （28/41） in group Ⅱ. The incidence of excrescence in the endocardium in group Ⅱ （65.85%） was higher than that in group Ⅰ （46. 88%）. The pathogens in group Ⅱ showed an increase of Gram-negative bacilli while a decrease of Gram-positive cocci than those in group Ⅰ . Conclusions The clinical patterns of pediatric IE has had changed with a decrease of positive blood culture but an increase of excrescence in the endocardium and Gram-negative bacilli in blood.
出处
《中华小儿外科杂志》
CSCD
北大核心
2006年第3期120-123,共4页
Chinese Journal of Pediatric Surgery
关键词
心内膜炎
细菌性
心脏外科手术
Endocarditis, bacterial
Cardiac surgical procedures
