摘要
目的探讨小儿暴发性心肌炎的临床特点及诊治策略。方法对2008年1月-2010年5月在本院住院治疗的14例暴发性心肌炎病例进行回顾性分析。其中男8例,女6例;年龄4个月8d～11岁,平均4.9岁。患儿均符合暴发性心肌炎的诊断标准,伴不同程度心功能不全、心源性休克、心律失常等,并除外先天性心脏病、风湿性心脏病等其他心脏疾病。确诊后给予卧床休息、吸氧、镇静,应用大剂量丙种球蛋白、肾上腺皮质激素、磷酸肌酸,并予抗病毒、纠正心律失常等治疗。结果 14例暴发性心肌炎患儿中,9例初诊时误诊,误诊率为64.29%(9/14例)。经治疗11例治愈或好转,1例于发病4个月转为扩张型心肌病,1例放弃治疗,1例死亡(发病2周转为扩张型心肌病)。患儿均存在心电图改变,包括Ⅲ度房室传导阻滞3例,Ⅰ度房室传导阻滞及不完全性右束支传导阻滞各2例,频发室性期前收缩及窦性心动过速各2例,左束支传导阻滞1例,广泛ST-T改变及低电压各1例。7例患儿CK-MB和肌钙蛋白I均升高,1例仅有肌钙蛋白I升高。结论暴发性心肌炎临床表现缺乏特异性,易误诊,但若能及时诊断、及时抢救,预后相对较好。其心电图的改变要早于心肌酶谱的升高。
Objective To explore the clinical characteristics and the strategies of diagnosis and treatment of fulminant myocarditis in children.Methods The data of 14 children with fulminant myocarditis hospitalized in Provincial Hospital Affiliated to Shandong University from Jan.2008 to May 2010 were analyzed retrospectively,including 8 male and 6 female,aged from 4 months and 8 days to 11years old（average age was 4.9 years old）.All the children were matched the diagnostic standard of fulminant myocarditis,accompanied with cardiac disfunction,cardiogenic shock and arrhythmia in different degrees,however,the children with congenital heart disease,rheumatic heart disease or other heart diseases were excluded.After confirmed diagnosis,all the 14 children were given bed rest,oxygen uptake and administration with creatine phosphate,antiviral agents,high dose of gamma globulin,adrenocortical hormone and antiarrhythmic drugs.Results Of 14 children,9 children were misdiagnosed in preliminary diagnosis,the misdiagnosis rate was 64.29%（9/14 cases）.Eleven children were cured or improved,1 child converted to dilated cardiomyopathy in 4 months after acute onset,1 child gave up,1 child died who converted to dilated cardiomyopathy at 2 weeks after acute onset.All the children had obvious changes in electrocardiogram,including 3 children with Ⅲ auriculo-ventricular block,2 children withⅠ auriculo-ventricular block,2 children with incomplete right bundle branch block,2 children with frequent ventricular premature beat,2 children with sinus tachycardia,1 child with left bundle branch block,1 child with extensive ST-T changes,and 1 child with low voltage.Seven children showed both creatine kinase-MB and cardiac troponin I（cTnI） elevation,1 child had only cTnI elevation.Chest radiograph of 9 children displayed cardiac enlargement.Conclusions Clinical manifestation of fulminant myocarditis rarely shows specificity,so it is prone to be misdiagnosed.But if diagnosis promptly and treatment appropriately,the prognosis of fulminant myocarditis can be excellent.And the changes of electrocardiogram are ealier than the changes of myocardium zymegram.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2011年第1期32-34,共3页
Journal of Applied Clinical Pediatrics
关键词
暴发性心肌炎
误诊
心电图
心肌酶谱
儿童
fulminant myocarditis
misdiagnosis
electrocardiogram
myocardium zymogram
child
