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目的探讨儿童感染性心内膜炎(IE)外科治疗时机。方法收集儿童IE病例43例。其中合并基础心脏病38例,予手术治疗28例,药物治疗10例;无基础心脏病5例,予手术治疗3例,药物治疗2例。结果行手术治疗IE者31例,全部治愈;药物治疗12例,近期死亡2例。手术治疗患儿随访27例,无死亡及心内膜炎复发等并发症,生活质量明显提高。结论儿童感染IE的临床特征和超声心动图的表现与成人患者心内膜炎表现相似,外科手术是治疗IE的有效手段,掌握手术时机是治愈本病的关键。急症手术治疗指征为心力衰竭恶化,心腔赘生物或瓣膜赘生物大于10mm者,经药物治疗难以控制的感染。儿童感染IE大多数有心脏结构异常,先天性心脏畸形,患儿应早期治疗,以减少IE的发生。
Objective To investigate the timing of surgical treatment of infective endocarditis (IE) in children. Methods 43 children with IE were collected. Among them, 38 cases were complicated with basic heart disease, 28 cases were treated surgically, 10 cases were treated with drugs, 5 cases were without basic heart disease, 3 cases were treated surgically and 2 cases were treated with drugs. Results The surgical treatment of IE in 31 cases, all cured; drug treatment in 12 cases, the recent death in 2 cases. Surgical treatment of children followed up 27 cases, no death and recurrence of endocarditis and other complications, quality of life improved significantly. Conclusion The clinical features and echocardiographic findings of children infected with IE are similar to those of endocarditis in adult patients. Surgery is an effective treatment for IE, and the key to cure this disease is to grasp the timing of surgery. Indications for acute surgical treatment of worsening heart failure, cardiac cavity or valve neoplasm more than 10mm, difficult to control the infection after drug treatment. Most children with IE have abnormal heart structure, congenital heart disease, children should be treated early to reduce the occurrence of IE.