CAJ | 학술논문

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。
목적탐토초성심동도재진단소인감염성심내막염중적림상응용개치。방법수집2005지2010년상해교통대학의학원부속신화의원수치적30례의사감염성심내막염환자적림상자료，분석소유환자적경흉초성심동도표현，관찰심장판막췌생물형태、대소、회성，분포급기판막공능병여혈배양이급혈청학시험결과대조。결과초차경흉초성심동도검사발현양성23례，음성7례。기중진양성22례，가양성1례，진음성4례，가음성3례。경흉초성심동도발현췌생물：삼첨판상7례，이첨판상2례，폐동맥판상3례，주동맥판상3례，폐동맥내3례，주동맥상췌생물합병판주농종형성2례，우심방내2례。1례판막수보술후환자초성진단위이첨판상췌생물，경다차반복검사증실위수술봉선。5례초차초성심동도검사음성적환자1주후복사，3례발현췌생물；2례인질병조기이사용항생소치료，소이미발현췌생물。초성심동도진단감염성심내막염적민감도위88.0%（22/25），특이도위80.0%（4/5）。조색상、서상급교대단괴상췌생물활동도대，수심장수축、서장래회파동；소결절상췌생물활동도소혹고정불동；개화적췌생물회성교강，부분반성영。27례혈배양（+），3례혈배양（-）。치병균주요위련구균（10주）、포도구균（10주）、가단포균（3주）、진균（4주）。결론감염성심내막염적조기진단대제고예후겁기중요。유우미생물배양시험소수시간교장，초성심동도가조기진단병가대췌생물진행정위，축단진단시간，대치료적결책급예후판단균유중요의의。
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.