摘要
目的探讨小儿暴发性心肌炎的临床特点及诊疗方法。方法对2003年1月-2009年12月收治的22例暴发性心肌炎患儿的临床表现及诊疗过程进行回顾性分析。结果 22例患儿中男17例,女5例;发病年龄为3个月～12岁,平均年龄4.2岁;于发病12h～13d入院。22例患儿均有心力衰竭表现,左室射血分数明显下降(25%～43%),9例有心源性休克,6例发生阿-斯综合征。心电图呈急性心肌梗死样改变7例,Ⅲ度房室传导阻滞6例,心房静止1例。均应用大剂量静脉用免疫球蛋白,总量2.0g.kg-1,分2～5d静脉滴注;大剂量糖皮质激素:地塞米松0.5～1.0mg·kg-1.d-1,逐渐减量,疗程4～8周;1,6-二磷酸果糖100～250mg·kg-1.d-1或磷酸肌酸0.5g.d-1或1.0g.d-1静脉滴注。Ⅲ度房室传导阻滞患儿中3例应用异丙肾上腺素治疗,分别于入院2～5d恢复正常窦性心律;余3例安装临时起搏器,2例20d后恢复自主窦性心律,拔除起搏器,1例治疗26d后植入永久起搏器;心房静止患儿安装临时起搏器23d后,转为非阵发性交界性心动过速,拔除临时起搏器。心电图呈心肌梗死样改变的7例患儿有3例遗留病理性Q波。22例中19例心腔内径及射血分数恢复正常,1例患儿1a后转化为扩张型心肌病,2例于入院2h内死亡。结论小儿暴发性心肌炎起病急、病情重、进展快、临床表现多样,大剂量静脉用免疫球蛋白疗效肯定,多数预后良好。
Objective To explore the clinical characteristics, diagnosis and treatment of fulminant myocarditis in children. Methods The clinical manifestations,process of diagnosis and treatment of 22 children with fulminant myocarditis from Jan. 2003 to Dec. 2009 were analyzed retrospectively. Results Twenty-two cases were enrolled including 17 boys and 5 girls,age ranged from 3 months to 12 years with mean age of 4.2 years. The time from onset to hospitalization was 12 hours to 13 days. Twenty - two children all had heart failure,with severely depressed left ventricular ejection fraction （25% -43% ）. Among them,9 cases had cardiogenie shock,6 cases suffered from Adams - Stoke syndrome. Electrocardiogram（ECG） abnormalities included mimicking acute myocardial infarction in 7 cases, degree III atrial ventricular bloek in 6 cases and atrial standstill in 1 case. All children were treated with high - dose intravenous immunoglobalin（ total dose 2.0 g · kg ^-1 , divided into 2 to 5 days infusion） , high - dose glucocorticoid （ dexamethasone 0.5 - 1.0 mg·kg^-1·d^-1, decrement gradually, time of therapy 4 -8 weeks） ,1,6 fructose diphosphate 100 -250 mg·kg^-1·d^-1 or creatine phosphate 0.5 g· d^-1 or 1.0 g· d^-1 intravenous drip. Three of 6 cases with degree III atrial ventricular block were treated with isoprenaline, regained normal sinus rhythm within 2 - 5 days, another 3 cases were implanted with temporary pacemaker ,2 cases regained normal sinus rhythm after 20 days and removed the pacemaker, 1 case was implanted with permanent pacemaker after treated for 26 days. The child with atrial standstill was implanted with temporary pacemaker turned into non - paroxysmal atrial ventricutar junctional tachycardia after 23 days and removed pacemaker. Three of 7 cases with ECG abnormalities mimicking acute myocardial infarction remained pathologic Q waves. Nineteen of 22 cases recovered completely with normal cardiac diameters and ejection fraction, 1 case converted into dilated cardiomyopathy after 1 year,2 cases
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第13期971-973,共3页
Journal of Applied Clinical Pediatrics
基金
国家"十一.五"科技支撑计划(2007BAI07A03)
山东省适宜卫生技术推广项目[鲁卫科教国合字(2009)38号]
关键词
暴发性心肌炎
诊断
治疗
静脉用免疫球蛋白
儿童
fulminant myocarditis
diagnosis
treatment
intravenous immunoglobulin
child
