儿童扩张型心肌病合并症临床研究

Clinical Analysis on Complications of Dilated Cardiomyopathy among Children

目的探讨小儿扩张型心肌病(DCM)的合并症及治疗合并症的临床意义。方法选择2004年5月—2013年5月吉林大学第一医院儿科住院诊治的DCM患儿59例,回顾性分析所有患儿的临床资料,包括临床症状、体征、实验室检查、合并症、药物治疗及转归。结果 59例DCM患儿临床表现多样,其中主要表现为心功能不全59例,呼吸困难45例,咳嗽25例,紫绀27例,水肿17例,血栓形成7例等。主要体征有双肺干湿性啰音59例,颈静脉怒张20例,心前区隆起20例,心尖抬举样搏动13例,弥散样搏动9例等。实验室检查:胸部X线片示心影增大59例(其中球形心7例),肺炎59例。心电图示心律失常44例,T波改变39例。彩色多普勒超声心动图示59例患儿均表现为全心增大,左室射血分数(LVEF)、缩短分数(FS)均降低。合并症:呼吸系统疾病为呼吸系统感染59例,肺炎59例;循环系统疾病为心力衰竭25例,心律失常44例;消化系统疾病为急性肝淤血35例;泌尿系统疾病为肾炎9例,尿路感染5例,肾衰竭4例;神经系统疾病为脑炎6例,脑栓塞2例;血液系统疾病为凝血障碍3例,贫血2例。59例患儿均规律服用强心药、利尿剂、血管紧张素转换酶抑制剂,对于其他系统的合并症给予相应的支持对症治疗。40例患儿病情好转出院,10例患儿死亡原因为心源性休克2例,心力衰竭8例,4例放弃治疗,5例转入上级医院治疗。结论 DCM可并发全身各个脏器的损害,在对DCM治疗的同时,也要注意对合并症的积极治疗,可改善患儿的心功能及预后。

Objective To investigate the complications of pediatric dilated cardiomyopathy（ DCM）,and the clinical significance of treating complications. Methods 59 children with DCM who were treated in Department of Pediatrics,the First Hospital of jilin University from May 2004 to May 2013,were selected as study subjects,clinical materials including symptoms, signs,auxiliary examination results, complications, drug treatment and outcome of all cases were analysed retrospectively. Results 59 cases with DCM showed diverse clinical manifestations, the main manifestation of 59 cases were cardiac insufficiency,of 45 cases were expiratory dyspnea,the main manifestation of 25 cases were cough,the main manifestation of 27 cases were cyanosis,the main manifestation of 17 cases was edema,the main manifestation of 7 cases was thrombosis. Main signs：59 cases of double lung sound moist rale or rhonchus,20 cases of distention of jugular vein,20 cases of protrusion of precordium,13 cases of apex beat up and down,9 cases of apex dispersion beat. Auxiliary examination：chest X-ray showed 59 cases of increased heart shadow（7 cases of spherical heart）,and 59 cases of pneumonia. Electrocardiogram showed 44 cases of arrhythmia and 39 cases of T wave changes. Color Doppler echocardiography showed 59 cases had whole heart enlargement, lower LVEF and FS. Complications：respiratory system disease：59 cases of infection,59 cases of pneumonia;circulation system disease：25 cases of heart failure,44 cases of arrhythmia;digestive system disease：35 cases of acute liver congestion;urinary system disease：9 cases of nephritis,5 cases of urinary tract infection,4 cases of renal failure;nervous system disease：6 cases of encephalitis,2 cases of cerebral embolism;hematological system disease：3 cases of blood coagulation disorders,2 cases of anemia. 59 cases were treated with cardiotonic drug,diuretic and ACE inhibitor,support and symptomatic treatment was used to treat complications of other systems. The condition of 40 cases improved and they were discharged,10 cases died（2 cases died of cardiogenic shock,8 cases died of heart failure）,4 cases gave up treatment,5 cases were transferred to higher level hospital. Conclusion Multiple systemic lesions may occur in children with DCM,cardiac function and prognosis of children can be further improved if both DCM and complications are treated.