儿童暴发性心肌炎临床分析

Clinical analysis of fulminant myocarditis in children

目的：探讨儿童暴发性心肌炎的临床特征。方法对北京儿童医院2007年1月至2013年5月收治的50例暴发性心肌炎患儿的病历资料进行回顾性分析，对其性别、年龄、临床表现及治疗、预后等进行总结。结果50例暴发性心肌炎患儿中，存在消化道症状16例（32．0％），心血管系统症状14例（28．0％），神经系统症状8例（16．0％），26．0％（13例）的患儿以阿斯综合征为首发表现，46例（92．0％）存在心电图异常表现，心肌酶指标及心脏彩色多普勒超声阳性率分别为48．0％（24例）和50．0％（25例）；32例给予丙种球蛋白输注，44例应用甲泼尼龙，28例Ⅲ度房室传导阻滞患儿在综合治疗基础上安装临时起搏器，4例患儿最终安装永久起搏器；对发生室性心动过速的20例患儿，6例应用利多卡因，7例应用胺碘酮进行转复，8例给予同步电复律，17例心动过速终止，1例安装临时起搏器后转复窦性心律，2例合并心室颤动的患儿经抢救无效死亡。结论儿童暴发性心肌炎的症状多样，多数不典型，误诊、漏诊率高；联合心电图、心脏彩色多普勒超声及心肌酶学指标诊断暴发性心肌炎的阳性率高，并对疾病的严重程度、预后有一定的提示作用。

Objective To investigate clinical characteristics of children with fulminant myocarditis . Methods The 50 cases of fulminant myocarditis were retrospectively analyzed .The children′s gender, age, clini-cal manifestations , treatment and prognosis were summarized .Results Among fifty cases of fulminant myocarditis in children,16 cases（32.0%） had digestive tract symptoms, 14 cases （28.0%） had cardiovascular symptom, 8 cases （16.0%） had nervous system symptoms .Asperger syndrome was the primary symptom in 26.0%of chil-dren;46 cases （92.0%） had abnormal electrocardiogram;positive rate of myocardial enzyme index and heart col-or doppler flow imaging were 48.0%（24 cases） and 50.0%（25 cases）;32 cases were given immunoglobulin in-fusion;44 cases had prednisolone; 28 cases with Ⅲ degree atrioventricular block had temporary pacemaker in-stalled based on the comprehensive treatment .4 cases were given final permanent pacemaker installation .6 cases had lidocaine;7 cases had amiodarone;8 cases were given synchronous cardioerter .17 tachycardia was termina-ted;one case had temporary pacemaker installed after converting sinus rhythm;2 cases with ventricular fibrillation died.Conclusions Most of children with fulminant myocarditis have diverse symptoms and most are not typical ;misdiagnosis rate is high .Comprehensive analysis of the results of electrocardiogram ,echocardiography and myocar-dial enzymology markers may improve the diagnosis of fulminant myocarditis and may also indicate the severity and prognosis.