小儿暴发性心肌炎的临床诊治及预后-附70例临床分析
发布时间：2018-11-06 06:58
【摘要】：目的：总结暴发性心肌炎（Fulminant myocarditis，FMC）患儿的临床诊断特点和治疗措施，为小儿FMC的及时诊断和治疗提供临床依据。 方法：回顾性分析重庆医科大学附属儿童医院1998年6月-2012年10月临床诊断FMC并收治住院的70例儿童的临床资料，从一般情况、临床表现、辅助检查结果、治疗方法及预后等方面进行归纳分析。应用SPSS19.0统计软件分析。 结果： 1.一般资料：70例FMC患儿，男性36例（51.43%），女性34例（48.57%），年龄7天至14岁，平均发病年龄（4.99±4.21）岁，起病后就诊时间最短15分钟，最长15天，3天内就诊46例。 2.临床表现：67例（95.71%）有明确的前驱感染史，首发症状以心外表现多见，其中呼吸系统（28.57%）与消化系统（27.14%）最常见，临床表现多以活动量下降（85.71%）、发绀（67.14%）、面色苍白（74.28%）等非特异性症状为主要表现，以心音低钝（95.71%）、律不齐（45.71%）为主要体征，易合并充血性心力衰竭（78.57%）、心源性休克（62.86%）、持续性室性心动过速（32.86%）或阿斯综合征（32.86%）等危急重症。 3.辅助检查： （1）病原学检查：柯萨奇病毒B组最常见。 （2）心肌酶谱与肌钙蛋白：本组病例94.44%（51/54）心肌酶谱有不同程度的异常，其中74.07%（40/54）肌酸激酶同功酶MB型（MBisoenzyme of creatine kinase，CK-MB）升高，31.11%（14/45）的患儿肌钙蛋白异常。治愈组CK-MB、谷草转氨酶、乳酸脱氢酶较死亡组低，治疗后的肌酸激酶、CK-MB、谷草转氨酶、乳酸脱氢酶、α-羟丁酸脱氢酶水平较治疗前降低，差别均有统计学意义（P0.05）。 （3）心电图（ECG）：以ST-T改变、T波改变及各型心律失常多见，异常比例93.85%（61/65）。 （4）心脏彩色超声心动图（UCG）：93.10%（27/29）患儿出现不同程度的异常，治愈组左室短轴缩短率水平较死亡组高（P0.05），治疗后的左室射血分数、左室短轴缩短率水平均较治疗前升高（P0.05）。 4.治疗情况：以综合、对症为主。糖皮质激素使用率为77.14%，使用组的治愈率（55.10%）比未使用组（8.33%）高（P0.05）；静脉丙种球蛋白（IVIG）使用率22.86%，同样，使用组的治愈率（68.75%）比未使用组（37.78%）高（P0.05）。 5.预后：70例患儿中，28例（40.00%）治愈，33例（47.14%）死亡，9例因自动放弃且失访而预后不详。 结论： 1.小儿FMC起病急、病情进展快，多数有病毒感染的前驱症状，临床表现多样，，首发症状以心外表现为主，其中呼吸消化系统多见，因而早期诊断困难，可迅速出现心力衰竭、心源性休克、阿斯综合征或严重心律失常等并发症，病死率高。 2.病原学以柯萨奇病毒B组最常见，CK-MB、肌钙蛋白升高是心肌炎的重要特征之一，ECG、UCG结果虽无特异性表现，但亦能为该病的诊断提供重要的临床依据。 3.FMC患儿早期综合使用糖皮质激素和IVIG治疗及积极的抢救对症治疗，可能可以使抢救成功率提高。
[Abstract]:Objective: to summarize the clinical diagnosis and treatment of fulminant myocarditis (Fulminant myocarditis,FMC) in order to provide clinical basis for the timely diagnosis and treatment of infantile FMC. Methods: the clinical data of 70 children with FMC diagnosed from June 1998 to October 2012 in affiliated Children's Hospital of Chongqing Medical University were retrospectively analyzed. Treatment methods and prognosis were summarized and analyzed. SPSS19.0 statistical software was used to analyze. Results: 1. General data: 70 children with FMC, 36 males (51.43%) and 34 females (48.57%), aged from 7 days to 14 years old, the average onset age was (4.99 卤4.21) years. 46 cases were treated in 3 days. 2. Clinical manifestations: 67 cases (95.71%) had a clear history of preemptive infection, and the first symptoms were mostly extracardiac, among which the respiratory system (28.57%) and digestive system (27.14%) were the most common. The main clinical manifestations were decreased activity (85.71%), cyanosis (67.14%), pale complexion (74.28%), low heart tone (95.71%) and irregular rhythm (45.71%). It is easy to be complicated with congestive heart failure (78.57%), cardiogenic shock (62.86%), persistent ventricular tachycardia (32.86%) or ASAS syndrome (32.86%). 3. Auxiliary examination: (1) Pathology examination: Coxsackie virus B group is the most common. (2) Myocardial enzyme spectrum and cardiac troponin: in this group, 94.44% (51 / 54) of the patients had abnormal myocardial zymogram, 74.07% (40 / 54) creatine kinase isoenzyme MB type (MBisoenzyme of creatine kinase,CK-MB increased. 31.11% (14 / 45) of children had abnormal cardiac troponin. The levels of creatine kinase, CK-MB, aspartate aminotransferase, lactate dehydrogenase and 伪 -hydroxybutyrate dehydrogenase in the cured group were lower than those in the dead group, and the levels of creatine kinase, CK-MB, glutamic oxaloacetic transaminase, 伪 -hydroxybutyrate dehydrogenase were decreased after treatment. The difference was statistically significant (P0.05). (3) ST-T, T wave and arrhythmias were the most common changes in (ECG):, and the abnormal rate was 93.85% (61 / 65). (4) (UCG): of cardiac color echocardiography was 93.10% (27 / 29) in children with different degrees of abnormality. The shortening rate of left ventricular short axis in the cured group was higher than that in the dead group (P0.05), and the left ventricular ejection fraction (LVEF) after treatment was significantly higher in the cured group than in the dead group (P0.05). The shortening rate of left ventricular short axis was higher than that before treatment (P0.05). 4. Treatment: comprehensive, symptomatic. The utilization rate of glucocorticoid was 77.14%, the cure rate in the use group (55.10%) was higher than that in the non-use group (8.33%) (P0.05). The utilization rate of intravenous immunoglobulin (IVIG) was 22.86%. Similarly, the cure rate in the use group (68.75%) was higher than that in the untreated group (37.78%) (P0.05). 5. Prognosis: among 70 cases, 28 cases (40.00%) were cured, 33 cases (47.14%) died. Conclusion: 1. Children with FMC have urgent onset and rapid progress. Most of them have the precursor symptoms of virus infection, and their clinical manifestations are diverse. The first symptoms are mainly extra-cardiac symptoms, in which the respiratory and digestive system is more common, so early diagnosis is difficult, and heart failure can occur rapidly. Cardiogenic shock, ASAS syndrome or severe arrhythmia and other complications, high mortality. 2. Coxsackie virus group B is the most common etiology. The elevation of CK-MB, troponin is one of the important characteristics of myocarditis. Although the results of ECG,UCG have no specific manifestation, they can provide important clinical basis for the diagnosis of the disease. Early comprehensive use of glucocorticoid and IVIG and active rescue therapy in children with 3.FMC may improve the success rate of rescue.
【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
[Abstract]:Objective: to summarize the clinical diagnosis and treatment of fulminant myocarditis (Fulminant myocarditis,FMC) in order to provide clinical basis for the timely diagnosis and treatment of infantile FMC. Methods: the clinical data of 70 children with FMC diagnosed from June 1998 to October 2012 in affiliated Children's Hospital of Chongqing Medical University were retrospectively analyzed. Treatment methods and prognosis were summarized and analyzed. SPSS19.0 statistical software was used to analyze. Results: 1. General data: 70 children with FMC, 36 males (51.43%) and 34 females (48.57%), aged from 7 days to 14 years old, the average onset age was (4.99 卤4.21) years. 46 cases were treated in 3 days. 2. Clinical manifestations: 67 cases (95.71%) had a clear history of preemptive infection, and the first symptoms were mostly extracardiac, among which the respiratory system (28.57%) and digestive system (27.14%) were the most common. The main clinical manifestations were decreased activity (85.71%), cyanosis (67.14%), pale complexion (74.28%), low heart tone (95.71%) and irregular rhythm (45.71%). It is easy to be complicated with congestive heart failure (78.57%), cardiogenic shock (62.86%), persistent ventricular tachycardia (32.86%) or ASAS syndrome (32.86%). 3. Auxiliary examination: (1) Pathology examination: Coxsackie virus B group is the most common. (2) Myocardial enzyme spectrum and cardiac troponin: in this group, 94.44% (51 / 54) of the patients had abnormal myocardial zymogram, 74.07% (40 / 54) creatine kinase isoenzyme MB type (MBisoenzyme of creatine kinase,CK-MB increased. 31.11% (14 / 45) of children had abnormal cardiac troponin. The levels of creatine kinase, CK-MB, aspartate aminotransferase, lactate dehydrogenase and 伪 -hydroxybutyrate dehydrogenase in the cured group were lower than those in the dead group, and the levels of creatine kinase, CK-MB, glutamic oxaloacetic transaminase, 伪 -hydroxybutyrate dehydrogenase were decreased after treatment. The difference was statistically significant (P0.05). (3) ST-T, T wave and arrhythmias were the most common changes in (ECG):, and the abnormal rate was 93.85% (61 / 65). (4) (UCG): of cardiac color echocardiography was 93.10% (27 / 29) in children with different degrees of abnormality. The shortening rate of left ventricular short axis in the cured group was higher than that in the dead group (P0.05), and the left ventricular ejection fraction (LVEF) after treatment was significantly higher in the cured group than in the dead group (P0.05). The shortening rate of left ventricular short axis was higher than that before treatment (P0.05). 4. Treatment: comprehensive, symptomatic. The utilization rate of glucocorticoid was 77.14%, the cure rate in the use group (55.10%) was higher than that in the non-use group (8.33%) (P0.05). The utilization rate of intravenous immunoglobulin (IVIG) was 22.86%. Similarly, the cure rate in the use group (68.75%) was higher than that in the untreated group (37.78%) (P0.05). 5. Prognosis: among 70 cases, 28 cases (40.00%) were cured, 33 cases (47.14%) died. Conclusion: 1. Children with FMC have urgent onset and rapid progress. Most of them have the precursor symptoms of virus infection, and their clinical manifestations are diverse. The first symptoms are mainly extra-cardiac symptoms, in which the respiratory and digestive system is more common, so early diagnosis is difficult, and heart failure can occur rapidly. Cardiogenic shock, ASAS syndrome or severe arrhythmia and other complications, high mortality. 2. Coxsackie virus group B is the most common etiology. The elevation of CK-MB, troponin is one of the important characteristics of myocarditis. Although the results of ECG,UCG have no specific manifestation, they can provide important clinical basis for the diagnosis of the disease. Early comprehensive use of glucocorticoid and IVIG and active rescue therapy in children with 3.FMC may improve the success rate of rescue.
【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
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