成人急性心肌炎合并Ⅲ度房室传导阻滞的临床分析

Clinical features of Ⅲ degree artrioventricular block following acute myocarditis in adult patients

目的探讨成人急性心肌炎合并Ⅲ度房室传导阻滞的临床特点。方法回顾性分析2002年1月至2015年12月北京安贞医院诊断为急性心肌炎的成人患者共108例，分为Ⅲ度房室传导阻滞组21例和非Ⅲ度房室传导阻滞组87例，对比观察两组临床特点、实验室及辅助检查、治疗方案和转归等。结果与非Ⅲ度房室传导阻滞组比较，急性心肌炎合并Ⅲ度房室传导阻滞组患者平均年龄相对较大[（35．0±11．3）岁比（26．1±9．0）岁，P=0．000]；急性心肌炎患者阿斯综合征发作率明显增多[11例（52．4％）比6例（6．9％），P=0．000]；共有19例（90．5％）患者恢复窦性心律，平均恢复时间为（4．6±3．9）d，有2例（9．5％）安装了永久起搏器。两组患者死亡无明显差异，其中Ⅲ度房室传导阻滞组无死亡病例。结论急性心肌炎合并Ⅲ度房室传导阻滞发病年龄相对较大，起病急，病情重，常伴有晕厥和阿斯综合征发作，常需植入临时起博器等治疗，预后良好。

Objective Acute myocarditis complicated with Ⅲ degree atrioventricular block is rare in adult. The purpose of this study was to report the outcome of acute myocarditis complicated with Ⅲ degree atrioventricular block in our hospital, in order to provide reference for clinical diagnosis and treatment. Methods A retrospective analysis of Beijing Anzhen Hospital during January 2002 to December 2015 for the diagnosis of acute myocarditis were 108 cases, divided into two groups, one group of Ⅲ degree atrioventricular block（ Ⅲ degree atrioventricular block group ） total 21 cases, another group of non m degree atrioventricular block （non Ⅲ degree atrioventricular block group） total 87 cases. The clinical features, laboratory examination, treatment and prognosis were compared between the two groups. Results There was a significant difference between the Ⅲ degree atrioventricular block group and the non Iil degree atrioventricular block group in the average onset age [ （36.0± 11.3）years vs （26.1±9.0）years, P=0.000]. Compared with the non m degree atrioventricular block group, Stokes-Adams seizures[ 11 （52.4%） vs 6（6.9% ）, P=-0.000] occurred in HI degree atrioventricular block group was significantly increased. There was no significant difference in mortality between the two groups, of which there were no deaths in the Ⅲ degree atrioventricular block group. Conclusion Ⅲ degree atrioventricular block following acute myocarditis in adult patients often characterized by acute onset, elder age and high risk. And they often accompanied by syncope and Adams-Strokes syndrome, had to implant temporary pacemaker. Although the disease can be life-threatening, the prognosis is excellent.