儿童风湿性心脏炎诊治临床分析(附136例报告)  

Diagnosis and treatment of rheumatic carditis in children:A report of 136 cases

作　　者：赵智慧[1] 高路[1] 袁越[1] 王勤[1] 林利[1] 崔烺[1] ZHAO Zhi-hui;GAO Lu;YU⁃AN Yue(Department of Cardiology,Beijing Children’s Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院心脏内科,北京100045

出　　处：《中国实用儿科杂志》2020年第5期387-390,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的总结风湿性心脏炎的临床特点及用心脏彩超评价治疗前后心脏结构及功能情况。方法回顾性分析2007年10月到2019年4月首都医科大学附属北京儿童医院收治的136例风湿性心脏炎患儿的临床特点,用心脏彩超评价治疗前与治疗后6个月心脏结构变化,分析抗风湿治疗的效果。结果风湿性心脏炎患儿临床症状部分不典型。心脏彩超表现以瓣膜返流最为常见(86.0%),其次为心脏增大(34.6%),极少存在心包积液(0.7%)。治疗前后二尖瓣、主动脉瓣、三尖瓣瓣膜返流程度差异有统计学意义(P<0.05)。左心室增大患儿治疗前左心室舒张末期前后径差异有统计学意义(P<0.05)。主动脉瓣狭窄及主动脉瓣脱垂者治疗前后均无明显改变。结论风湿性心脏炎患儿经积极早期抗风湿及对症治疗后,瓣膜返流可较前减少,扩大的心脏可较前缩小,大部分射血分数减低患儿的射血分数升高,心包积液消失,但瓣膜狭窄及脱垂多无明显改善。Objective To summarize the clinical characteristics of rheumatic carditis and evaluate the structure and function of the heart before and after treatment with color Doppler ultrasound.Methods The clinical characteristics of 136 children with rheumatic carditis admitted between October 2007 and April 2019 to Beijing Children’s Hospital,Capital Medical University,were summarized retrospectively.Cardiac structural ultrasound was used to evaluate the changes of cardiac structure before and 6 months after treatment,and the effect of anti-rheumatic treatment was analyzed.Results The clinical symptoms of children with rheumatic carditis were partially atypical.Cardiac ultrasound showed that valve regurgitation was the most common(86.0%),followed by enlarged heart(34.6%),and pericardial effusion was rare(0.7%).There were significant differences in mitral,aortic,and tricuspid valve regurgitation before and after treatment,and the differences were statistically significant(P<0.05).In children with left ventricular enlargement the difference in left ventricular end diastolic diameter before and after treatment was statistically significant(P<0.05).Aortic valve stenosis and aortic valve prolapse did not change significantly before and after treatment.Conclusion In children with rheumatic carditis after early anti-rheumatic and symptomatic treatment,valvular regurgitation can be reduced compared to before.The enlarged heart can be reduced compared to before,and the ejection fraction of most children with reduced ejection fraction is increased.The pericardial effusion disappears,but most valve stenosis and prolapse dose not improve significantly.

关 键 词：风湿性心肌炎 治疗效果 超声心动图 

分 类 号：R72[医药卫生—儿科]