成人急性心肌炎的病例特点分析

Analysis of the Characteristics of Adult Patients With Acute Myocarditis

目的 总结急性心肌炎的临床特点,为临床诊治提供参考。方法回顾性分析2013年1月~2015年12月于我院心内科住院的急性心肌炎患者,总结临床资料,分析症状、检查结果、合并症、治疗和预后。结果 84例急性心肌炎中有46例重症心肌炎。与非重症心肌炎组比,重症心肌炎组QRS波更宽、LVEF更低、心包积液更多,糖皮质激素和丙种球蛋白应用更多,住院日更长。重症心肌炎中41.3%合并心源性休克,7例植入IABP;43.5%存在高度房室传导阻滞,30.4%行临时起搏器,1例植入永久性起搏器。共有3例住院期间死亡。结论重症心肌炎在临床表现、治疗上有别于非重症心肌炎;对于严重心律失常、心源性休克等并发症,器械治疗发挥了重要作用。

Objective Reviewing the clinical features of adult acute myocarditis,in order to provide assistance to the clinical management. Methods Patients hospitalized ill the cardiology department from January 2013 to December 2015 with acute myocarditis were reviewed retrospectively. Their clinical data were collected. Their symptoms, complications, treatment and outcome were analyzed. Results 84 patients with acute myocarditis were included, among which 46 patients were identified as fulminant myocarditis. Compared to non-fulminant group, the ffdminant group had greater QRS wave width, worse LVEF, and more pericardial effusion. Gamma-globulin and glucocorticoid were more frequently used in the fulminant groupand the fulminant group had a longer hospital stay. Cardiogenic shock happened on 41.3% patients with fulminant myocarditis, and 7 patients used IABP. 43.5% the presence of a high degree of atrioventricular block, 30.4% temporary pacemaker, 1 patients with permanent pacemaker implantation. A total of 3 patients died during hospitalization. Conclusion Acute fulminant myocarditis had different manifestations and treatment. Mechanical therapy played an important role in the treatment of patients with acute myocarditis complicated by severe arrhythmias and cardiogenic shock.