Abdel-Haq Nahed, Moussa Zeinab, Farhat Mohamed Hani, Chandrasekar Leela, Asmar Basim I
Division of Infectious Diseases, Children's Hospital of Michigan, Detroit, MI, USA.
Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, MI, USA.
Int J Pediatr. 2018 Nov 8;2018:5450697. doi: 10.1155/2018/5450697. eCollection 2018.
The study was undertaken to determine the etiology, review management, and outcome in children diagnosed with acute pericarditis during 11 years at tertiary pediatric institution.
Retrospective chart review of children diagnosed between 2004 and 2014. Patients with postsurgical pericardial effusions were excluded.
Thirty-two children were identified (median age 10yr/11mo). Pericardiocentesis was performed in 24/32 (75%) patients. The most common cause of pericarditis was infection in 11/32 (34%), followed by inflammatory disorders in 9 (28%). Purulent pericarditis occurred in 5 children including 4 due to : 2 were methicillin resistant (MRSA). All patients with purulent pericarditis had concomitant infection including soft tissue, bone, or lung infection; all had pericardial drain placement and 2 required pericardiotomy and mediastinal exploration. Other infections were due to (2), (2), Influenza A (1), and Enterovirus (1). Pericarditis/pericardial effusion was the initial presentation in 4 children with systemic lupus erythematosus including one who presented with tamponade and in 2 children who were diagnosed with systemic onset juvenile inflammatory arthritis. Tumors were diagnosed in 2 patients. Five children had recurrent pericarditis. Systemic antibiotics were used in 21/32 (66%) and prednisone was used in 11/32 (34%) patients.
Infections remain an important cause of pericarditis in children. Purulent pericarditis is most commonly caused by and is associated with significant morbidity, need of surgical intervention, and prolonged antibiotic therapy. Echocardiography-guided thoracocentesis remains the preferred diagnostic and therapeutic approach. However, pericardiotomy and drainage are needed when appropriate clinical response is not achieved with percutaneous drainage.
本研究旨在确定一所三级儿科机构11年间诊断为急性心包炎的儿童的病因、回顾治疗方法及预后。
对2004年至2014年间诊断的儿童进行回顾性病历审查。排除术后心包积液患者。
共确定32例儿童（中位年龄10岁11个月）。24/32（75%）例患者进行了心包穿刺术。心包炎最常见的病因是感染，共11/32（34%）例，其次是炎症性疾病9例（28%）。5例儿童发生化脓性心包炎，其中4例病因如下：2例为耐甲氧西林金黄色葡萄球菌（MRSA）。所有化脓性心包炎患者均伴有感染，包括软组织、骨或肺部感染；均进行了心包引流，2例需要心包切开术和纵隔探查。其他感染病因包括[具体病因未给出]（2例）、[具体病因未给出]（2例）、甲型流感（1例）和肠道病毒（1例）。心包炎/心包积液是4例系统性红斑狼疮儿童的首发表现，其中1例出现心脏压塞，2例被诊断为全身型幼年特发性关节炎。2例患者诊断为肿瘤。5例儿童发生复发性心包炎。21/32（66%）例患者使用了全身抗生素，11/32（34%）例患者使用了泼尼松。
感染仍然是儿童心包炎的重要病因。化脓性心包炎最常见的病因是[具体病因未给出]，并伴有严重的发病率、需要手术干预和长期抗生素治疗。超声心动图引导下胸腔穿刺术仍然是首选的诊断和治疗方法。然而，当经皮引流未取得适当临床反应时，需要进行心包切开术和引流。
