38例小儿肥厚型心肌病临床分析

发布时间：2018-04-29 00:09

本文选题：肥厚型心肌病 + 儿童　；参考：《重庆医科大学》2013年硕士论文

【摘要】：目的：总结小儿肥厚型心肌病临床特点，减少误诊漏诊，为早期识别、明确诊断和判断预后提供指导。方法：回顾性分析1993年11月-2012年12月本院38例肥厚型心肌病住院患儿，从年龄、性别、地区，临床表现，辅助检查，病情转归等方面进行总结。结果：收集38例，随访30例（随访率78.9%）。小儿肥厚型心肌病常见临床表现为生长发育落后（50.0%）、气促（34.2%）、乏力/活动量下降（21.1%）、心悸（15.8%）、晕厥(7.9%)、头晕（7.9%）、发绀（7.9%），同时合并呼吸道感染症状如咳嗽（52.6%）、发热（21.1%）。大部分患儿有心脏杂音（55.3%），，部分有肝脏肿大（34.2%）表现。而年长儿或成人较为典型的表现如劳力性呼吸困难、胸痛在本组患儿中没有出现。心电图、24小时动态心电图、超声心动图、心脏磁共振等辅助检查明确疾病诊断，评估预后。该病需与引起心室肥厚的疾病（如高血压、主动脉缩窄、嗜铬细胞瘤等）鉴别，监测血压有重要价值。随访患儿中死亡者比例较高，占40.0%，可能与发病年龄小、病情严重、合并严重呼吸道感染有关。综合临床表现，完善相关辅助检查，明确疾病诊断，进一步评估风险和判断预后。结论：小儿肥厚型心肌病临床表现多样化，较成人不典型，容易误诊和漏诊。该病的诊断主要依靠辅助检查。首次出现症状的年龄越小者，预后越差。
[Abstract]:Objective: to summarize the clinical characteristics of hypertrophic cardiomyopathy in children, reduce misdiagnosis and misdiagnosis, and provide guidance for early identification, diagnosis and prognosis. Methods: 38 hospitalized children with hypertrophic cardiomyopathy from November 1993 to December 2012 were retrospectively analyzed in terms of age, sex, area, clinical manifestation, auxiliary examination and prognosis. Results: 38 cases were collected and 30 cases were followed-up (follow-up rate 78.9%). The common clinical manifestations of hypertrophic cardiomyopathy in children were as follows: 50. 0% growth and development retardation, 34. 2% shortness of breath, 21. 1% of fatigue / activity, 15. 8% of palpitation, 7. 9% of syncope, 7. 9% of dizziness, 7. 9% of cyanosis. At the same time, the symptoms of respiratory tract infection such as cough 52.6%, fever 21. 1% were involved. Most of them had heart murmur 55.3 and some had hepatomegaly. The typical manifestations of elderly or adult children, such as laborious dyspnea, chest pain did not occur in this group. 24-hour ambulatory electrocardiogram, echocardiography and cardiac magnetic resonance were used to diagnose the disease and evaluate the prognosis. The disease needs to be distinguished from diseases that cause ventricular hypertrophy (such as hypertension, aortic coarctation, pheochromocytoma, etc.) and monitoring of blood pressure is of great value. The proportion of death was higher (40.0%) in the follow-up children, which may be related to the younger age, the severe disease and the severe respiratory tract infection. Comprehensive clinical manifestations, improve the relevant auxiliary examination, clear diagnosis, further assessment of risk and prognosis. Conclusion: the clinical manifestations of hypertrophic cardiomyopathy in children are more diversified than those in adults, and are more easily misdiagnosed and missed. The diagnosis of the disease mainly depends on auxiliary examination. The younger the first symptom, the worse the prognosis.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.4

【参考文献】