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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 clinical features of children with infective endocarditis and pathogenic bacteria changes for further clinical diagnosis and treatment. Methods The clinical data of 73 surgical patients with infective endocarditis in children under 14 years old in our hospital during 10 years were retrospectively analyzed. The clinical data of 32 patients (group Ⅰ) from January 1995 to December 1999 were compared with 41 patients (group Ⅱ) from January 2000 to December 2004, and the changes of clinical features were compared between the two groups Pathogen changes. Results 73 cases accounted for 7.3% (73/998) of the total number of hospitalized children in the same age group in the same period, while those in group Ⅱ (41 / 671,6.1%) were lower than those in group Ⅰ (32 / 327,9.8%, P <0.05) ). Sixty-six patients had underlying heart disease, including 47 cases of ventricular septal defect (VSD), 15 cases of patent ductus arteriosus (PDA) and 4 cases of other cases. The detection rate of heart neoplasms was higher in group Ⅱ (27/41, 65.9%) than in group Ⅰ (15/32, 46.9%, P <0.01). 59 cases of blood culture positive, 14 cases of blood culture negative. The positive rates of total bacterial culture were 73.9% (54/73), 96.88% (31/32) in group I and 68.29% (28/41) in group Ⅱ. The detection rate of heart neoplasms increased from 46.9% (15/32) in group Ⅰ to 65.9% (27/41) in group Ⅱ. The pathogen spectrum of children IE changed significantly, the positive rate of Gram-positive cocci was significantly reduced, but the detection rate of Gram-negative bacilli was significantly increased. Conclusion The clinical features of surgical treatment of children with infective endocarditis have some changes, the positive rate of blood culture decreased, while the detection rate of heart neoplasm increased. The proportion of gram-negative bacilli in the pathogens of children IE was significantly higher.