疑似病毒性心肌炎儿童频发房性期前收缩的近期随访

发布时间：2018-12-07 12:03

【摘要】：目的病毒性心肌炎是儿童常见的心血管疾病,但是典型病毒性心肌炎或重症心肌炎发生率低,临床多见以频发期前收缩为主要临床表现的儿童,无或有轻微的心肌酶升高,对于这一部分患者,病毒性心肌炎不能确诊也不能排除,并进一步决定着相关的治疗。我院儿科对此类病例按病毒性心肌炎治疗后,确有部分患者期前收缩明显减少,反证了病毒性心肌炎的诊断。基于此,我们回顾性分析我院儿科自2002年至2012年收治的伴有频发房性期前收缩的此类病例,总结其治疗效果,分析其心电学指标,探讨疑似病毒性心肌炎儿童频发房性期前收缩的特点及近期预后,以为此类病例的诊治提供依据。方法调阅我院儿科自2002年至2012年收治的以频发房性期前收缩为主要临床表现的疑似病毒性心肌炎患儿41例,总结其临床特点,包括有无前驱感染史,有无心功能不全或心源性休克的症状,心肌酶、超声心动图、心脏正位片等辅助检查结果,回顾性分析其动态心电图特点包括异位心搏总数,是否为房性并行心律,有无合并房性心动过速,联律间期是否固定,期前收缩的起源、形态等,并对营养心肌治疗后房性期前收缩总数的变化进行统计描述,对动态心电图特点与预后的关系进行统计推断。结果 130例(73%)全天房性期前收缩总数小于20000,4例(10%)为房性并行心律,35例(85%)心房异位P'波可提前至T波,14例(32%)合并房性心动过速,多数病例期前收缩为单源性、起源于心房下部。 2给予两周抗病毒、营养心肌、抗氧化及中成药治疗后,半数患儿房性期前收缩减少超过30%。 3合并房性心动过速者比单纯频发房性期前收缩者近期预后好(P0.05)。结论疑似病毒性心肌炎儿童的频发房性期前收缩,尤其是合并房性心动过速者,多为病毒性心肌炎引起,按病毒性心肌炎治疗可使期前收缩减少或消失。
[Abstract]:Objective viral myocarditis is a common cardiovascular disease in children, but the incidence of typical viral myocarditis or severe myocarditis is low. There is no or slight increase in myocardial enzymes, and for this group of patients, viral myocarditis cannot be diagnosed and ruled out, and further related treatment is determined. After treatment with viral myocarditis in paediatrics, some of the patients did have a marked decrease in phase contraction, which confirmed the diagnosis of viral myocarditis. Based on this, we retrospectively analyzed the patients with frequent atrial premature contraction in pediatrics from 2002 to 2012, summarized their therapeutic effects, and analyzed their ECG indexes. To investigate the characteristics and prognosis of frequent atrial premature contraction in children with suspected viral myocarditis, and to provide evidence for the diagnosis and treatment of these cases. Methods from 2002 to 2012, 41 children with suspected viral myocarditis with frequent atrial premature contraction as the main clinical manifestation were reviewed, and their clinical characteristics were summarized, including whether they had a history of precancerous infection. Whether there are symptoms of cardiac insufficiency or cardiogenic shock, myocardial enzyme, echocardiography, positive position radiography and other auxiliary examination results, the dynamic electrocardiogram features, including the total number of ectopic cardiac beats, whether atrial concurrent rhythm, were analyzed retrospectively. With or without atrial tachycardia, whether the syntonic interval is fixed or not, the origin and morphology of the premature contraction, etc., and the changes of the total number of atrial premature contractions after the treatment of nutritious myocardium were statistically described. The relationship between the characteristics of ambulatory electrocardiogram (ECG) and prognosis was statistically inferred. Results in 130 cases (73%), the total number of total atrial premature contractions was less than 20 000% (10%) in 4 cases (10%), atrial concurrent rhythm in 35 cases (85%), atrial ectopic P 'wave in 35 cases (85%), atrial tachycardia in 14 cases (32%), atrial tachycardia in 14 cases (32%). In most cases, the preterm contraction was monogenic and originated in the lower atrium. 2 after two weeks of antiviral, nutritional myocardial, antioxidant and traditional Chinese medicine treatment, the atrial premature contraction decreased by more than 30% in half of the children. 3The short-term prognosis of patients with atrial tachycardia was better than that of patients with simple frequent atrial premature contraction (P0.05). Conclusion the frequent atrial premature contraction in children with suspected viral myocarditis, especially in patients with atrial tachycardia, is mostly caused by viral myocarditis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.1

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