暴发性心肌炎71例临床特点分析

Clinical observation on 71 cases of fulminant myocarditis

目的：探讨小儿暴发性心肌炎的临床特点。方法纳入2006年1月~2013年8月北京儿童医院住院治疗的暴发性心肌炎患者71例，对其病例资料进行回顾性分析，包括性别、年龄、临床表现、心电图和心肌生化标志物改变以及治疗效果和预后。结果71例患者中共有男性31例，女性40例，年龄3个月~14.5岁，平均（6.1±1.8）岁；最常见的临床表现为呼吸道感染（42.25%）和消化道感染（33.80%）。85.92%（61/71）存在肌酸激酶同功酶（CK-MB）或心肌肌钙蛋白I（cTnI）升高，90.14%（64/71）存在显著的心电图改变。所有患者均进行抗病毒治疗，并予甲泼尼龙及丙种球蛋白进行免疫治疗，同时针对不同患者情况采取抗休克、纠正心力衰竭和抗心律失常等综合治疗，18例出现Ⅲ度房室传导阻滞的患儿安装了临时起搏器。87.3%的患儿经治疗后好转（62/71），死亡7例（9.9%），其中3例患儿因心力衰竭导致多脏器功能衰竭死亡，1例因频繁发作室性心动过速合并肺部感染死亡，2例QRS波群低电压合并室内传导阻滞死亡，1例因心力衰竭合并肺水肿而死亡；另有2例放弃治疗。结论暴发性心肌炎临床表现多样，多伴有心电图异常和心肌生化标志物升高，经过积极治疗多数预后良好。

Objective To discuss the clinical characteristics of fulminant myocarditis in child patients. Methods The patients （n=71） were chosen hospitalized in the Beijing Children’s Hospital from Jan. 2006 to Aug. 2013. Their medical data was retrospectively analyzed, including sex, age, clinical manifestations, changes of electrocardiogram （ECG） and myocardial enzyme, curative effect and prognosis.Results Among 71 cases, there were 31 male cases and 40 female ones. Their ages were from 3 months old to 14.5 years old [average （6.1±1.8） years old]. The most common clinical manifestations were respiratory tract infection （42.25%） and digestive tract infection （33.80%）. There were 85.92% （61/71） cases had increased CK-MB or cTnI, and 90.14% （64/71） had significant ECG changes. All patients were given anti-viral treatment and immune treatment with MPIV and gamma globulin, and different patients were given therapies of anti-shock, correcting heart failure and antiarrhythmia respectively. The patients （n=18） with grade III atrioventricular block were implanted temporary pacemakers. There were 87.3%（62/71） cases abated after treatment, 7 （9.9%） died （3 due to multiple organ failure induced by heart failure, 1 due to frequent ventricular tachycardia complicating pulmonary infection, 2 due to QRD complex low voltage complicating intraventricular block, 1 due to heart failing complicating pulmonary edema and two due to abandoning treatment）. Conclusion The clinical manifestations are multiple in the patients with fulminant myocarditis accompanied by abnormal ECG and higher myocardial enzyme. Most of them have good prognosis after treatment.