2019 年第 8 期 第 14 卷

引起儿童心脏杂音的常见原因分析

Research on common causes of heart murmurs in children

作者：陈丽焦萌金梅

英文作者：

单位：100029首都医科大学附属北京安贞医院小儿心脏中心

英文单位：

关键词：心脏杂音；先天性心脏病；病因

英文关键词：

• 摘要：

• 【摘要】目的    探讨引起儿童心脏杂音的常见原因。方法    选取2018年9月至2019年1月在首都医科大学附属北京安贞医院小儿心脏中心以发现心脏杂音为主诉就诊的106例患儿。其中男48例（45.3%）、女58例（54.7%），年龄4 d～13.75岁，中位年龄8个月（1个月，2.08岁）。详细询问所有患儿的病史并进行体格检查、听诊及超声心动图检查。结合病史资料、杂音特征、超声心动图检查结果进行深入分析。结果    106例患儿中，82例（77.4%）杂音位于胸骨左缘第2～3或3～4肋间，余位于心尖部；56例（52.8%）患儿杂音为1级，43例（40.6%）杂音响度在2～3级，仅7例（6.6%）患儿杂音为3级；多数杂音局限，无传导。28例（26.4%）患儿存在先天性心脏病，其中6例房间隔缺损，16例室间隔缺损，5例轻度肺动脉瓣狭窄，1例单心室（B型）合并大动脉转位。杂音为3级及为2～3级者存在先天性心脏病比例明显高于杂音为1级者［100.0%（7/7）、37.2%（16/43）比8.9%（5/56）］，差异有统计学意义（χ2=30.887，P<0.001）。50例年龄≤6个月的患儿中，19例（38.0%）存在先天性心脏病；56例年龄>6个月的患儿中，9例（16.1%）存在先天性心脏病。年龄≤6个月存在心脏杂音患儿先天性心脏病比例明显高于年龄>6个月患儿，差异有统计学意义（χ2=6.535，P=0.011）。结论    儿童心脏杂音为1级者及年龄>6个月者均多数为生理性杂音，杂音为2级以上及年龄≤6个月患儿存在先天性心脏病比例均较高。

• 【Abstract】Objective    To explore the common causes of heart murmurs in children. Methods    One hundred and six children with heart murmurs, including 48 males(45.3%) and 58 females(54.7%), with a median age of 8 months(quartile 1 month, 2.08 years; range 4 d-13.75 years) who visited Beijing Anzhen Hospital, Capital Medical University from September 2018 to January 2019 were included. General data, medical history, physical examination, auscultation findings(heart murmurs) and results of echocardiography were analyzed. Results    Heart murmurs were found at 2-3 or 3-4 intercostals of left sternal margin in 82 cases(77.4%); the rest was found at the apex of the heart. Heart murmur loudness was grade 1 in 56 cases(52.8%), grade 2-3 in 43 cases(40.6%) and grade 3 in 7 cases(6.6%). Most murmurs were limited and non-conductive. Echocardiography examination showed 28 cases(26.4%) of congenital heart disease(CHD), including 6 cases of atrial septal defect, 16 cases of ventricular septal defect, 5 cases of mild pulmonary valve stenosis and 1 case of single ventricle（type B） with transposition of the great arteries. Prevalence of CHD in children with murmur loudness grade 3 and grade 2-3 was significantly higher than that in children with murmur loudness grade 1［100.0%（7/7）, 37.2%（16/43） vs 8.9%（5/56）］（χ2=30.887， P<0.001）. Prevalence of CHD in children with age≤6 months was 38.0%(19/50), which was significantly higher than that in children with age>6 months［16.1%（9/56）］（χ2=6.535， P=0.011）. Conclusions    Heart murmurs with loudness grade 1 and heart murmurs in children over 6 months old are more likely to be physiological murmurs. Heart murmurs with loudness grade 2 or above and heart murmurs in young children(≤6 months old) may indicate high possibility of CHD.