埃塞俄比亚亚的斯亚贝巴三级国家转诊医院儿童心包积液：基于 7 年机构的回顾性研究。
Pericardial effusion in children at tertiary national referral hospital, Addis Ababa, Ethiopia: a 7-year institution based review.
机构信息
Department of Pediatrics and Child Health, Yekatit 12 Medical College, Addis Ababa, Ethiopia.
Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
BMC Emerg Med. 2024 Jan 7;24(1):6. doi: 10.1186/s12873-023-00922-7.
BACKGROUND
Pericardial effusion (PE) is a rare yet an important cause of child mortality due to collection of excess fluid in pericardial space. The study aimed to describe the PE profile in the national cardiac referral hospital, Addis Ababa, Ethiopia.
METHODS
The study employed cross-sectional study design for a 7-year review of childhood PE in Tikur Anbessa Specialized Hospital. Descriptive and analytic statistics were applied.
RESULTS
There were 17,386 pediatric emergency/ER admissions during the study period, and PE contributed to 0.47% of ER admissions. From 71 included subjects, 59% (42) were males with mean age of 7.8 ± 3.3 years. Cough or shortness of breath,73.2% (52) and fever or fast breathing, 26.7% (19), were the common presenting symptoms. The median duration of an illness before presentation was 14days (IQR: 8-20). The etiologies for pericardial effusion were infective (culture positive-23.9%, culture negative-43.6%, tuberculous-4.2%), hypothyroidism (4.2%), inflammatory (12.7%), malignancy (7%) or secondary to chronic kidney disease (1. 4%). Staphylococcus aureus was the most common isolated bacteria on blood culture, 12.7% (9) while the rest were pseudomonas, 7% (5) and klebsiella, 4.2% (3). Mild, moderate and severe pericardial effusion was documented in 22.5% (16), 46.5% (33), and 31% (22) of study subjects, respectively. Pericardial tamponade was reported in 50.7% (36) of subjects. Pericardial drainage procedure (pericardiocentesis, window or pericardiotomy) was performed for 52.1% (37) PE cases. The case fatality of PE was 12.7% (9). Pericardial drainage procedure was inversely related to mortality, adjusted odds ratio 0.11(0.01-0.99), p 0.049).
CONCLUSION
PE contributed to 0.47% of ER admissions. The commonest PE presentation was respiratory symptoms of around two weeks duration. Purulent pericarditis of staphylococcal etiology was the commonest cause of PE and the case fatality rate was 12.7%. Pericardial drainage procedures contributed to reduction in mortality. All PE cases should be assessed for pericardial drainage procedure to avoid mortality.
背景
心包积液（PE）是由于心包腔内积聚过多液体导致儿童死亡的罕见但重要原因。本研究旨在描述埃塞俄比亚亚的斯亚贝巴国家心脏转诊医院的心包积液特征。
方法
本研究采用横断面研究设计，对提克里安贝萨专科医院 7 年来的小儿心包积液进行回顾性研究。采用描述性和分析性统计方法。
结果
在研究期间，有 17386 名儿科急诊/急诊就诊，心包积液占急诊就诊的 0.47%。在纳入的 71 名受试者中，59%（42 名）为男性，平均年龄为 7.8±3.3 岁。咳嗽或呼吸急促，73.2%（52 名）和发热或呼吸急促，26.7%（19 名）是常见的首发症状。就诊前疾病的中位病程为 14 天（IQR：8-20）。心包积液的病因包括感染（培养阳性-23.9%，培养阴性-43.6%，结核-4.2%）、甲状腺功能减退（4.2%）、炎症（12.7%）、恶性肿瘤（7%）或继发于慢性肾脏病（1.4%）。金黄色葡萄球菌是血液培养中最常见的分离菌，占 12.7%（9 例），其余为假单胞菌，占 7%（5 例）和克雷伯菌，占 4.2%（3 例）。研究对象中轻度、中度和重度心包积液分别为 22.5%（16 例）、46.5%（33 例）和 31%（22 例）。50.7%（36 例）的患者出现心包填塞。52.1%（37 例）的心包积液患者行心包引流术（心包穿刺、开窗或心包切开术）。心包积液的病死率为 12.7%（9 例）。心包引流术与死亡率呈负相关，校正比值比为 0.11（0.01-0.99），p=0.049）。
结论
心包积液占急诊就诊的 0.47%。最常见的心包积液表现为持续约两周的呼吸道症状。葡萄球菌性化脓性心包炎是心包积液最常见的病因，病死率为 12.7%。心包引流术有助于降低死亡率。所有心包积液患者均应评估心包引流术以避免死亡。
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