上海地区小儿暴发型心肌炎50例临床分析

Clinical manifestations of 50 children with fulminant myocarditis in Shanghai

目的探讨小儿暴发型心肌炎临床特点及有效、安全的诊治方法。方法收集自1984年1月-2006年3月上海地区6所医院收治的50例病例资料进行回顾性分析。结果50例患儿经治疗痊愈36例,好转2例,死亡12例,死亡率24．0％。临床特点为:好发年龄以学龄期儿童为主;均有前驱症状,以呼吸道、消化道症状多见,半数以上伴发热;起病急、进展快、起病初期以心外症状为主,表现为面色苍白、多汗、乏力、腹痛、抽搐等,起病24-48 h内出现严重心律失常和心功能不全;辅助检查以心电图改变最敏感且具有多样性;患儿自然病程约一个月。结论小儿暴发型心肌炎是一类严重威胁儿童生命的疾病,以抗心律失常和保护心肌为主,并应用心脏临时起搏的综合疗法,是一种有效、安全的治疗方法。

Objectives To investigate the clinical characteristics of children with fulminant myocarditis and the more effective method of diagnosis and therapy. Methods Data of 50 children with fulminant myocarditis who were diagnosed by 6 hospitals in Shanghai from January 1984 to March 2006 were collected. Results Among them 36 recovered, 2 were improved and the other 12 patients died. Mortality of the total 50 cases was 24.0 %. Clinical characteristics included （1） Children at school age were susceptible to fulminant myocarditis. （2） Precursory symptoms especially those of respiratory and digestive systems were occurred in all patients, with more than a half had fever. （3） Most patients presented with extra-cardiac symptoms such as pale, hyperidrosis, asthenia, abdominal pain and convulsion during early stage,, and within 24-48 hours severe arrhythmia and heart dysfunction occurred. （4） Various abnormalities were found in EKG of patients, which became the most sensitive accessory examination. （5） The natural course of the 50 cases was approximately one month. Conclusions Fulminant myocarditis is a critical disease which may cause patients death. Combined treatment of antiarrhythmia and protection of damaged myocardium with appliance of temporary pacing were concluded as effective and safe.