| 王 涛,华益民,周开宇,王一斌,段泓宇,李一飞,王 川,乔莉娜.16例儿童暴发性心肌炎的临床回顾性分析[J].,2017,17(14):2659-2662 |
| 16例儿童暴发性心肌炎的临床回顾性分析 |
| Clinical Retrospective Analysis of 16 Children with Fulminant Myocarditis |
| 投稿时间：2016-09-13 修订日期：2016-09-30 |
| DOI：10.13241/j.cnki.pmb.2017.14.013 |
| 中文关键词: 儿童 暴发性心肌炎 诊断 救治 回顾性分析 |
| 英文关键词: Children Fulminant myocarditis Diagnosis Treat Analyze |
| 基金项目: |
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| 中文摘要: |
| 摘要 目的：通过对儿童急性暴发性心肌炎的临床表现、实验室指标、抢救治疗和转归进行回顾性分析研究，探讨小儿暴发性心肌炎的临床特点及有效安全的救治方法。方法：收集并分析2008年1月-2012年12月四川大学华西第二医院符合纳入标准的急性暴发性心肌炎16例, 回顾性分析临床表现、心电图、心脏B超、血清生化指标、抢救治疗方法及预后，并总结其诊断和抢救治疗的特点。结果：16例暴发性心肌炎以学龄期儿童为主，平均年龄（7.19±4.69）岁，入院时有消化道症状表现者10例（62.5%），有呼吸道症状表现者7例(43.75%)，有循环灌注不足表现者10例(62.5%)，有心脏症状(心悸、胸痛)表现者6例（37.5%），其中8例伴发热(50%)。16例暴发性心肌炎患儿入院时X线胸片9例异常表现（56.25%），其中心影增大3例，肺水肿/充血5例，胸腔积液6例；超声心动图检查8例有异常表现（50%），平均射血分数（EF）为（50±15）% ，平均缩短分数（FS）为（29±15）%，左心室增大5例，左室收缩功能下降4例，瓣膜反流4例，心包积液3例；心电图均有不同程度异常表现（100%），其中Ⅲ度阻滞8例（50%）；肌钙蛋白升高者15例（93.75%）。抢救治疗过程中，15例使用甲强龙冲击治疗(93.75%)，11例使用丙种球蛋白冲击治疗(68.75%)，8例安置临时起搏器(50%)，5例行呼吸机支持(31.25%)，4例行血液净化治疗(25%)。其中6例于急性期死亡（37.5%），平均住院日5.3天，10例存活并好转出院，平均住院日26.5天，出院1月门诊随访，患者心肌酶、肝肾功能正常，超声心动图恢复正常，2例有继发性癫痫后遗症并长期口服抗癫痫药物。16例暴发性心肌炎中，9例合并多器官功能障碍综合征（56.25%），其中4例重症多器官功能衰竭患儿予以呼吸机辅助通气、安置临时起搏器并连续性血液净化联合治疗，3例存活，1例死亡。结论：暴发性心肌炎起病急，病情重，起病初期多以心外症状为主，易误诊漏诊，急性期死亡率高，对疑诊病例应行心电图、超声心动图、胸片检查并综合判断。一旦确诊需早期予抗心力衰竭，心源性休克，抗心律失常治疗。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the clinical manifestations, laboratory indexes,rescue therapy and prognosis of children with fulminant myocarditis retrospectively,and to explore the clinical characteristics and effective treatment of children with fulminant myocarditis. Methods: Collected and analyzed 16 children with fulminant myocarditis who were treated in the West China Second University Hospital of Sichuan University from January 2008 to 2012 December, retrospective analyzed the clinical manifestations, ECG,cardiac ultrasound, serum biochemical indicators, rescue therapy and prognosis, and summarized the characteristics of diagnosis and treatment. Results:16 cases of fulminant myocarditis was mainly in school age children, the average age was (7.19+4.69) years. On admission, there were 10 cases (62.5%) with digestive tract symptoms, 7 cases (43.75%) with respiratory symptoms,10 cases (62.5%) with circulatory insufficiency, 6 cases (37.5%) with heart symptoms (heart palpitations, chest pain). Among them, 8 cases were accompanied with fever (50%). 16 children with fulminant myocarditis in the chest X-ray revealed 9 cases of abnormal performance (56.25%). Among them, there were 3 cases of cardiac shadow increase, 5 cases of Pulmonary edema/congestion and 6 cases of pleural effusion. Echocardiography showed abnormal expression in 8 cases (50%), mean ejection fraction (EF) was (50+15)%, the mean fractional shortening (FS) was (29+15)%, left ventricular enlargement in 5 cases, left ventricular systolic function decreased in 4 cases,valve regurgitation in 4 cases, pericardial effusion in 3 cases; ECG showed different degrees of abnormal performance(100%),Ⅲdegree block in 8 cases (50%), troponin elevation in 15 cases (93.75%). 15 cases were treated with Methylprednisolone pulse therapy in the process of rescue treatment (93.75%), 11 cases were treated with immunoglobulin therapy (68.75%), 8 cases were treated with temporary pacemaker (50%), 5 cases were treated with ventilator support (31.25%), 4 cases were treated with blood purification (25%). Among them, 6 cases died in the acute phase (37.5%), the average length of stay was 5.3 days, 10 cases were survived and discharged from hospital, average length of stay was 26.5 days. Outpatient follow-up was carried out 1 month after discharge,patients with myocardial enzymes, liver and kidney function were normal, echocardiography returned to normal, 2 cases had secondary epilepsy sequelae and long-term taken orally antiepileptic drugs,there were 9 cases with multiple organ dysfunction syndrome (56.25%) in 16 children with fulminant myocarditis, 4 children with severe multiple organ failure were treated by ventilator assisted ventilation, placement of temporary pacemaker and continuous blood purification combined treatment, with 3 cases survived and 1 cases died. Conclusion: The fulminant myocarditis is urgent, and the condition is serious, the symptoms were mainly outside the heart in the early stage of the disease,which is easy to be misdiagnosed, the mortality is high in acute stage, for suspected cases should be treated with electrocardiogram,echocardiography, chest X-ray examination and comprehensive judgment. As soon as the diagnosis is made, it is necessary to treat the patients with heart failure, cardiac shock and cardiac arrhythmia. |
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