以腹痛为主要表现的心肌损害33例

Myocardial Damage Presented with Abdominal Pain in 33 Children

目的探讨以腹痛为主要表现的小儿心肌损害的病因、临床特点、治疗及转归。方法对近4a本院儿科临床诊断的以腹痛为主要表现的33例心肌损害患儿的临床资料进行总结分析。患儿均除外急诊外科疾病。结果 33例以腹痛为主要表现的心肌损害患儿中,支气管肺炎10例,支气管炎9例,上呼吸道感染7例,过敏性紫癜、心肌炎各1例,不明原因5例。腹痛病程2d～3个月,腹痛无规律性,持续时间不固定,肺炎支原体抗体阳性5例(3例肺炎、2例支气管炎)。33例患儿均有不同程度心肌受累的症状和体征。24h动态心电图:23例均存在ST-T改变,其中17例伴多发室性期前收缩(伴二、三联律7例,伴房性期间收缩4例)。CK-MB增高21例(30～124U.L-1),心肌肌钙蛋白I增高19例(0.8～1.2ng·L-1)。胸片心影增大7例(心胸比率0.55～0.58)。超声心动图:左心室舒张末期内径增大5例,右心房增大1例。经营养心肌、治疗原发病,腹痛症状多于5～7d缓解,最长为14d。疗程多为2周～1个月,最长3个月。1例心肌炎患儿在3个月时再次出现腹痛,延长治疗至6个月,未再发作。结论对于以腹痛就诊的小儿,在除外急诊外科疾病、腹部器质性病变的同时,应注意心脏方面的检查,及早发现心肌损害,尽早治疗。

Objective To investigate the clinical characteristics, treatment and prognosis of myocardial damage preseqted with abdominal pain in children. Methods The clinical data of 33 children with myocardial damage presented with abdominal pain in Beijing Anzhen Hospital during the past 4 years were analyzed. Emergency conditions were ruled out in all cases. Results Among 33 cases with myocardial daluage presented with abdominal pain,there were 10 cases of pneumonia,9 cases of acute bronchitis,7 cases of upper respiratory tract infection, 1 case of allergic purpura, 1 case of myocarditis and 5 cases of unknown causes. The duration of abdominal pain lasted 2 days to 3 months. The characteristics and the duration of abdominal pain were irregular. Mycoplasma antibodies positive were 5 cases （2 cases of bronchitis,3 cases of pneumonia）. Coxvirus antibodies were 2 cases. There were different symptoms and signs of myocardial damage. Holter：there were ST - T changes in 23 children and 17 frequent premature ventricular complex （pattern of bigeminy and trigeminy in 7 children, premature atrial cornpl6x in 4 children）. Creatine kinase isoenzyme - MB were high in 21 children（30 - 124 U ·L^-1 ）. Cardiac troponin I were high in 19 children（0.8 - 1.2 ng ·L^-1）. Chest X -ray ：cardiomegaly was noted in 7 children,and the ratio of cardiac and chest were 0.55 -0.58. Echocardiography：the left ventricular end- diastolic diameter was enlarged in 5 children, the right atrium was enlarged in 1 child. Most abdominal pain was relieved with treatment in 5 to 7 days,and 14 days was the longest. Total treatment course was 2 weeks to 1 month,and 3 months was the longest. But 1 case with myocarditis was recurrent abdominal pain treated nearly 3 months,and lasted to 6 months for recovery. Conclusions It is important to pay attention to cardial examination early, when a child becomes inconsolable from abdominal pain but emergency conditions should be ruled out.