摘要
目的 探讨暴发型心肌炎的临床特点,为临床诊治提供参考.方法 回顾分析我院2005年1月至2012年12月间诊断病毒性心肌炎患者183例的资料,对其中153例急性心肌炎（急性心肌炎组）和30例暴发型心肌炎（暴发型心肌炎组）的临床特点、发病年龄、症状、实验室及辅助检查、治疗方式及转归等进行比较.结果 暴发型心肌炎组与急性心肌炎组患者平均年龄相似[（22.3±7.6）岁比（26.2±12.6）岁,P=0.105 5],有明确的前驱感染症状的患者比例[30.0％（9/30）比78.4％（120/153）,χ^2=28.3,P＜0.001]、平均潜伏时间[（3.1±2.2）d比（7.0±3.8）d,P＜0.001]、平均住院时间[（12.1±6.9）d比（6.9±4.5）d,P＜0.001]比较差异均有统计学意义.急性心肌炎组的起病症状以胸闷（101/153,66.0％）、乏力（76/153,49.7％）、心慌（74/153,48.4％）为主,而暴发型心肌炎组的起病症状以胸闷（24/30,80.0％）、气急（14/30,46.7％）、乏力（13/30,43.3％）为主.暴发型心肌炎组主要并发症有高度房室传导阻滞（19/30,63.3％）、心源性休克（18/30,60.0％）、室性心律失常（16/30,53.3％）、阿斯综合征（8/30,26.7％）、急性肾衰竭（8/30,26.7％）等;其中有11例患者植入临时起搏器,7例患者使用体外膜肺氧合（ECMO）,7例患者植入主动脉内球囊反搏（IABP）辅助;住院期间21例治愈,9例（30.0％）死亡,出院后1例植入永久起搏器,1例转变为慢性心肌炎反复住院.结论 暴发型心肌炎起病急骤,多缺少典型前驱症状或前驱感染期,潜伏时间较普通急性心肌炎短.及时有效的器械辅助治疗对暴发型心肌炎抢救和预后有积极作用.
Objective To review the clinical features of fulminant myocartitis,in order to provide assistance to the clinical management.Methods The clinic data of 183 patients with viral myocarditis,including 153 cases of acute myocarditis and 30 cases of fulminant myocarditis admitted in our hospital during January 2008 and Dec 2012 were retrospectively analyzed.The age of onset,interval after virus infect,initial symptoms,auxiliary examination,treatment,and turnover were compared in the study.Results The average onset age of fulminant myocartitis and acute myocarditis were similar [（22.3 ± 7.6） vs.（26.2 ± 12.6） years,P =0.105 5].There was a significant difference between the two gourps in the rate of patients with a explicit history of virus infection [30.0% （9/30） vs.78.4% （120/153）,χ^2 =28.3,P 〈0.001],the average interval after virus infect [（3.1 ±2.2） vs.（7.0 ±3.80） d,P〈0.001] and the length of hospital stay [（12.1 ± 6.9） vs.（6.9 ± 4.50） d,P 〈 0.001].Chest congestion （101/153,66.0%）,feebleness （76/153,49.7%）,fluster （74/153,48.4%） are the most onset symptoms of acute myocarditis,while chest congestion （24/30,80.0%）,shortness of breath （14/30,46.7%）,feebleness （13/30,43.3%） in flunimant myocarditis.Advanced A-V block （19/30,63.3%）,cardiogenic shock （18/30,60.0%）,ventricular arrhythmia（16/30,53.3%）,Adams-Stokes syndrome（8/30,26.67%） and acute renal failure （8/30,26.7%） were the most complications of flunimant myocarditis.Temporary pacemaker （11 cases）,extracorporeal memberane exygenator （7 cases） and intra-aortic balloon pump （7 cases） were applied in critical patients.In acute phase,21 cases were cured,9 cases was dead of cardiogenic shock and ventricular（27,30.0%）.Two dead cases applied with ECMO because of delay.After leaving hospital,1 case was implanted permanent pacemaker,2 cases became chronic myocarditis and required hospitalization repeatedly.Conclusions The fulminant myocarditis has a rapid onset,most of whi
出处
《中华全科医师杂志》
2015年第1期24-28,共5页
Chinese Journal of General Practitioners
关键词
心肌炎
诊断
临床特点
Myocarditis
Clinical feature
Diagnosis
