暴发型心肌炎预后相关因素研究

Study of Relative Factors about Prognosis of Fulminant Myocarditis

目的 分析影响暴发型心肌炎预后情况的相关因素.方法 本研究统计自2005年1月～ 2012年12月期间笔者医院诊治的暴发型心肌炎患者30例,分析患者的临床症状、实验室检查、治疗方式,对出院后情况进行跟踪随访.结果 30例暴发型心肌炎患者平均年龄22.33＆#177;7.62岁,起病症状以胸闷（80.00％）、气急（46.67％）、乏力（43.33％）为主.主要并发症有高度房室传导阻滞（63.33％）、心源性休克（60.00％）、室性心律失常（53.33％）、阿斯综合征（26.67％）、急性肾衰竭等（26.67％）.其中有11例患者植入临时起搏器,7例患者使用ECMO,7例患者植入IABP辅助.暴发型心肌炎患者住院期间21例治愈,9例（27％）死亡,其中2例救治不够及时,使用ECMO治疗仍无效.死亡患者均死于住院1周内.左心室收缩功能低下、出现心源性休克、使用机械通气和暴发型心肌炎急性期死亡相关.3例左心室射血分数低（EF＜50％）患者出院1个月后复查超声心动图提示恢复正常,11例ST-T心梗样心电图患者,出院1个月后心电图均恢复正常.21例暴发型心肌炎患者出院后随访,心功能均恢复正常（NYHA Ⅰ）,2例患者复发;普通急性心肌炎患者出院后随访50例,有2例患者出院后复发,复发患者均表现为急性心肌炎,营养支持治疗后好转.结论 暴发型心肌炎住院期间病死率高,左心室收缩功能低下、出现心源性休克、使用机械通气和暴发型心肌炎急性期死亡相关,暴发型心肌炎出院后预后较好,和急性心肌炎比较差异无统计学意义.

Objective To analyze the relative factors about prognosis of fulminant myocarditis. Methords The clinical information of 30 cases patients of fulminant myoearditis who received treatment in out hospital during Jan 2008 and Dec 2012 was reviewed. The clin- ical sign, lab examnition, treatment, and the condition discharged were recorded in follow - up. Results The average onset age of fulmi- nant myocarditis is 22.33 ＋ 7.62 years old, chest congestion （ 80.00% ） , shortness of breath（49.67% ） , feebleness（43.33% ） were the most onset symptoms of acute myocarditis. Temporary pacemaker（ 11 cases） , extracorporeal memberane exygenator（7 cases） and intra - aortic balloon pump（7 cases） were applied in critical patients. In acute phase, 21 cases were cured, 9 cases was dead（27% ）. Two dead cases applied with ECMO because of delay. These dead cases were died within one week after be in hostipital. Low ventricular ejection fraction, cardiogenic shock,and mechanical ventilation were relatived with dead of fulminant myocarditis in acute phase. Three cases with low left ventrieular ejection fraction（ EF 〈 50% ） who reviewed the echoeardiography was normal one month later. Besides 11 cases with ST- T wave imitated myocardiac infarction was normal one month later. In follow -up of 21 cases of fulminant myocarditis, their heart functions were recovered（ NYHA [ ） , and 2 cases relapsed, while 2 cases relapsed in the follow - up of 50 cases of acute myocarditis. The relapsed cases all dignosed with acute myocarditis, and cured by nutritional supportive therapy. Conclusion The fulminant myocar- ditis has a high mortality during hospitalization. Low ventricular ejection fraction, cardiogenic shock and mechanical ventilation were rela- rived with dead of fulminant myocarditis in acute phase. The prognosis of fulminant myocarditis is favorable, and these is no difference compared to acute myocarditis.