超声心动图诊断小儿感染性心内膜炎的临床应用价值  

Clinical value of echocardiography in diagnosing infective endocarditis in children

作　　者：郁怡[1] 孙锟[2] 陈笋[2] 薛海虹[2] 杨健萍[2] 

机构地区：[1]上海交通大学医学院附属新华医院超声诊断科,200092 [2]上海交通大学医学院附属新华医院小儿心脏中心,200092

出　　处：《中华医学超声杂志（电子版）》2013年第8期633-638,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨超声心动图在诊断小儿感染性心内膜炎中的临床应用价值。方法收集2005至2010年上海交通大学医学院附属新华医院收治的30例疑似感染性心内膜炎患者的临床资料,分析所有患者的经胸超声心动图表现,观察心脏瓣膜赘生物形态、大小、回声,分布及其瓣膜功能并与血培养以及血清学试验结果对照。结果初次经胸超声心动图检查发现阳性23例,阴性7例。其中真阳性22例,假阳性1例,真阴性4例,假阴性3例。经胸超声心动图发现赘生物:三尖瓣上7例,二尖瓣上2例,肺动脉瓣上3例,主动脉瓣上3例,肺动脉内3例,主动脉上赘生物合并瓣周脓肿形成2例,右心房内2例。1例瓣膜修补术后患者超声诊断为二尖瓣上赘生物,经多次反复检查证实为手术缝线。5例初次超声心动图检查阴性的患者1周后复查,3例发现赘生物;2例因疾病早期已使用抗生素治疗,所以未发现赘生物。超声心动图诊断感染性心内膜炎的敏感度为88.0%(22/25),特异度为80.0%(4/5)。条索状、絮状及较大团块状赘生物活动度大,随心脏收缩、舒张来回摆动;小结节状赘生物活动度小或固定不动;钙化的赘生物回声较强,部分伴声影。27例血培养(+),3例血培养(-)。致病菌主要为链球菌(10株)、葡萄球菌(10株)、假单胞菌(3株)、真菌(4株)。结论感染性心内膜炎的早期诊断对提高预后极其重要。由于微生物培养试验所需时间较长,超声心动图可早期诊断并可对赘生物进行定位,缩短诊断时间,对治疗的决策及预后判断均有重要意义。Objective To evaluate the value of echocardiography in diagnosing infective endocarditis (IE) in children. Methods The shape, size, echogenicity, distribution of vegetations and valvular function of the heart were observed by transthoracic echocardiography (TTE) in 30 patients with suspected IE. We correlated TTE ifndings with the results of hemoculture and serologic test. Results Vegetations were observed in all patients by echocardiography:seven patients with tricuspid valve vegetations, two with mitral valve vegetations, three with pulmonary valve vegetations, three with main pulmonary artery vegetations, three with aortic valve vegetations, two with aortic valve abscess, and two with vegetations in right atrium. After anti-infection therapy, the size of vegetations in iffteen patients became smaller and the less echogenic than before. Vegetations disappeared in two patients. Vegetation was recurrent repeatedly in one case. Ten patients recovered after operation. Two severe cases died. Five patients underwent TTE again one week after the previous negative TTE. Of them, echocardiography demonstrated vegetations in three cases. However, no vegetations were found in rest two cases because antibiotics had been used at early stage. In addition, echocardiography demonstrated one patient with mitral valve vegetation. But the lesion was ifnally conifrmed to be operating suture. The sensitivity and specificity of TTE in detecting vegetations were 88.0% and 80.0%, respectively. Blood cultures were positive in twenty-seven cases and were negative in three cases. Conclusions The early diagnosis of IE is important to improve patient′s prognosis. It takes a long time in organism cultivation before achieving the clinical diagnosis. TTE can help obtain an early diagnosis stage of IE, and provide the assessment of size and location of vegetation. It plays an important role in treatment and prognosis prediction.

关 键 词：超声心动描记术 心内膜炎 儿童 

分 类 号：R445.1[医药卫生—影像医学与核医学] R725.4[医药卫生—诊断学]