重症病毒性心肌炎——附48例分析并文献复习

Acute severe viral myocarditis: analysis of 48 cases and review of literature

目的分析重症病毒性心肌炎的诊断和治疗,旨在避免误诊,提高抢救成功率.方法对1999年5月～2003年5月收治的48例重症病毒性心肌炎患者的临床特点、心电图及诊治经过进行分析.结果本研究48例重症病毒性心肌炎患者中,39例(81.3%)首发临床表现均为胃肠道症状,4例(8.3%)为呼吸道症状,仅5例(10.4%)为心脏症状,呈现不典型性.心电图呈频发室早22例(45.8%),酷似广泛性急性心肌梗死早期图形10例(20.8%),短阵室速8例(16.7%),房室传导阻滞5例(10.4%),窦速伴T波或ST段改变3例(6.3%).病初误诊率85.4%.甲基泼尼松龙冲击治疗组存活率(96.7%)显著大于未使用甲基泼尼松龙的对照组(55.6%),P＜0.05.结论对临床上首发表现为非心脏症状而血流动力学异常的患者,应立即行心电图检查,任何形式的心电图异常均应立即考虑重症病毒性心肌炎的可能.甲基泼尼松龙冲击治疗可阻遏病情的恶化.

Objective To analyse the atypical point of acute severe viral myocarditis clinically and discuss its diagnosis and treatment. Methods The clinical characteristics,ECGs and treatments of 48 patients with acute severe viral myocarditis were analysed. Results 39 patients presented with gastrointestinal symptoms (81.3%), 4 with respiratory symptoms (8.3%) and only 5 with cardiovascular symptoms (10.4%).ECG showed frequent premature ventricular beats (45.8%), pseudo myocardial infarction in patterns of the very early period (20.8%), paroxysmal ventricular tachycardia (16.7%), atrioventricular block(10.4%), sinus tachycardia and the changes of T waves or ST segment(6.3%), respectively. The misdiagnosed rate was 85.4% in the early course. 29 of 30 treated with methylprednisolone survived (96.7%). 10 of 18 with no methylprednisolone survived (55.6%). Conclusion It is suggested that ECG should be performed as early as possibly in the patients with abnormal hemodynamics and no cardiovascular symptoms. The possible diagnosis about acute severe viral myocarditis should be considered quickly when any abnormalisty of ECG is discovered. The intense treatment of methylprednisolone can stop the deterioration of severe viral myocarditis.