112例成人急性心肌炎的临床分析

发布时间：2018-06-24 13:06

本文选题：急性心肌炎 + 临床分析　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:总结分析成人急性心肌炎的临床资料,归纳其临床特征,为疾病早期诊断、提高治愈率提供科学依据。方法:回顾性分析吉林大学第一医院心血管疾病诊治中心2006年1月至2016年12月收治的112例成人急性心肌炎病例的临床资料,包括性别、发病年龄、住院天数、血压、心率、临床表现、辅助检查、诊断、治疗及转归情况等。以急性重症心肌炎为重症心肌炎组,其余为非重症心肌炎组。以酷似心肌梗死的急性心肌炎为酷似心梗心肌炎组,其余为非酷似心梗心肌炎组。总结成人急性重症心肌炎和酷似心肌梗死心肌炎的临床特征。应用SPSS23.0统计软件分析以上临床资料并得出结论。结果:112例成人急性心肌炎患者中,男性65例(58.0%),女性47例(42.0%),男、女比例1.38:1,平均发病年龄为33.46±13.52岁。有前驱感染史者79例(70.5%),以发热(41.1%)、咽痛(26.7%)、咳嗽(20.5%)常见。心电图以不同程度ST-T改变和心律失常多见(85.7%)。心脏彩超以不同部位、程度的室壁节段性运动异常多见(33.0%)。112例患者中,104例(92.9%)治愈或好转,2例病危要求出院,6例死亡。重症心肌炎组30例(26.8%),非重症心肌炎组82例(73.2%)。重症心肌炎组心率、AST、LDH、WBC、Ne、NT-pro BNP高于非重症心肌炎组,LVEF低于非重症心肌炎组(P0.05)。多因素Logistic回归分析显示,LVEF降低是急性心肌炎发展为急性重症心肌炎的独立危险因素。酷似心梗心肌炎组41例(36.6%),酷似心梗心肌炎组AST,LDH,cTnI较非酷似心梗心肌炎组高(P0.05)。结论:1、急性心肌炎患者多数存在呼吸系统感染等前驱症状。2、重症心肌炎组心率、AST、LDH、WBC、Ne、NT-pro BNP高于非重症心肌炎组,LVEF低于非重症心肌炎组。3、LVEF降低是急性心肌炎发展为急性重症心肌炎的独立危险因素。4、酷似心梗心肌炎组AST,LDH,cTnI较非酷似心梗心肌炎组高,急性心肌炎与急性心肌梗死难以鉴别时,建议尽早行冠脉造影检查,避免延误病情。
[Abstract]:Objective: to summarize and analyze the clinical data of adult acute myocarditis, summarize its clinical characteristics, and provide scientific basis for early diagnosis and improvement of cure rate. Methods: the clinical data of 112 adult patients with acute myocarditis admitted from January 2006 to December 2016 in the Cardiovascular Disease Center of the first Hospital of Jilin University were retrospectively analyzed, including sex, age of onset, length of stay, blood pressure and heart rate. Clinical manifestation, auxiliary examination, diagnosis, treatment and prognosis. Acute severe myocarditis was regarded as severe myocarditis group, and the rest was non-severe myocarditis group. Myocardial infarction-like acute myocarditis was seen as myocardial infarction-like myocarditis group, and the rest was non-myocardial infarction-like myocarditis group. To summarize the clinical features of acute severe myocarditis and myocardial infarction-like myocarditis in adults. SPSS 2 3.0 statistical software was used to analyze the above clinical data and draw a conclusion. Results among 112 adult patients with acute myocarditis, 65 (58.0%) were male and 47 (42.0%) female. The ratio of male to female was 1.38: 1. The average age of onset was 33.46 卤13.52 years old. There were 79 cases (70.5%) with history of preinfection. Fever (41.1%), sore throat (26.7%) and cough (20.5%) were common. ST-T changes and arrhythmias were more common in electrocardiogram (85.7%). Abnormal segmental motion of ventricular wall was more common in different parts and degrees of echocardiography (33.0%). 104 cases (92.9%) were cured or improved. 6 cases died. There were 30 cases (26.8%) in severe myocarditis group and 82 cases (73.2%) in non-severe myocarditis group. In severe myocarditis group, the heart rate of ASTX LDHN WBCU neNT-pro BNP was higher than that of non-severe myocarditis group (P 0.05), and LVEF was lower than that of non-severe myocarditis group (P0.05). Multivariate logistic regression analysis showed that the decrease of LVEF was an independent risk factor for the development of acute myocarditis to acute severe myocarditis. There were 41 cases (36.6%) in myocardial infarction like myocarditis group, and the AST LDH cTnI group was higher than that in non-myocardial infarction like myocarditis group (P 0.05). Conclusion: 1, most of the patients with acute myocarditis have respiratory system infection and other precursor symptoms. In severe myocarditis group, the heart rate is higher than that in non-severe myocarditis group. The decrease of LVEF is lower than that of non-severe myocarditis group. The decrease of LVEF is that the acute myocarditis develops into acute severe myocarditis, and the decrease of LVEF is higher in severe myocarditis group than in non-severe myocarditis group. The independent risk factor of myocarditis. 4. The ASTU LDHnI group was higher than that in the non-myocardial infarction myocarditis group, which was similar to the myocardial infarction myocarditis group, and the risk factor was higher in the myocardial infarction myocarditis group than in the non-myocardial infarction myocarditis group. When it is difficult to distinguish acute myocarditis from acute myocardial infarction, coronary angiography should be performed as soon as possible to avoid delay.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.21

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