主动脉内球囊反搏治疗急性重症病毒性心肌炎临床分析及预后随访

Influence of intra-aortic balloon pump on treatment and prognosis of acute severe viral myocarditis

目的 总结主动脉内球囊反搏（intra-aortic balloon pump,IABP）在急性重症病毒性心肌炎患者治疗中的作用.方法 收集2001年1月至2010年12月急性重症病毒性心肌炎患者共63例并进行随访,比较IABP应用与否对临床疗效的影响,用多因素Logistic回归分析住院治愈的相关因素.结果 成人急性重症病毒性心肌炎占同期急性心肌炎住院患者43.15％,住院病死率为19.05％,整体住院病死率呈逐渐下降趋势.使用IABP组较未使用IABP组患者治愈率明显升高（100％ vs.73.9％,Х^2=3.92,P=0.048）,无IABP相关并发症发生;Logistic回归分析发现住院治愈与较高的左心室射血分数（left ventricular ejection fraction,LVEF）及IABP的使用相关.经治愈出院的患者随访6-12个月中,两组均无死亡,心功能纽约心脏协会（NYHA）分级和LVEF均较基线明显改善,差异有统计学意义（P＞0.05）.结论 急性重症病毒性心肌炎住院治愈与LVEF及IABP的使用相关,早期使用IABP支持治愈率明显提高,该病治愈出院患者预后良好.

Objectives To analyze the characteristics of treatment and outcome of intra-aortic balloon pump （IABP） in patients with acute severe viral myocarditis,especially for its influence on in-hospital mortality and prognosis.Methods A total of 63 patients with acute severe viral myocarditis were enrolled from January 2001 to December 2010.They were followed up for 6-12 months after discharge.Therapeutic effects of treatment with or without IABP application were analyzed.Related factors were analyzed with multivariate logistic regression.Results Adult acute severe viral myocarditis constituted 43.15% of acute myocarditis,with a in-hospital mortality rate of 19.05%,which decreased gradually in the last 10 years.Cure rate of treatment with IABP application was significantly higher than that without IABP （100% vs.73.9%,Х^2=3.92,P=0.048）.No complication of IABP occurred.Regression analysis demonstrated that cure rate was associated with preserved left ventricular ejection fractions （LVEF） and utility of IABP.After 6-12 months＇ follow-up,no death occurred,while two patients without previous IABP support progressed into dilated cardiomyopathy.Recovery of grade in New York Heart Association （NYHA） and LVEF in patients with IABP was not significantly different with those without IABP during follow-up,but much better than the basic conditions （P〉0.05）.Conclusions LVEF and utility of IABP are related to cure rate in patients with acute severe viral myocarditis.Early utility of IABP is safe and significantly improves cure rate and outcome.Patients with acute severe viral myocarditis after recovery have favorable prognosis.