临时起搏抢救儿童暴发性心肌炎23例报道并文献复习

Temporary cardiac pacing to rescue children with fulminant myocarditis:a report of 23 cases and literature review

目的:分析临时起搏在儿童暴发性心肌炎抢救过程中的治疗作用和效果,探索暴发性心肌炎患儿的起搏指征及预后情况。方法:对23例安装临时起搏器的暴发性心肌炎患儿的临床资料进行回顾性总结分析并文献复习。结果:23例患儿急性起病,进展迅速,短期内即出现危及生命的恶性心律失常、急性血流动力学障碍。在大剂量激素、丙种球蛋白等药物治疗的基础上安装临时起搏器辅助治疗,全部存活出院,且82.6%的患儿恢复窦性心律。结论:暴发性心肌炎合并药物治疗无效的严重心律失常或危及生命的急性血流动力学紊乱时,及时临时起搏辅助治疗是一项安全、有效的急救措施,有利于为后续治疗赢得时间。

Objective:To analyze the therapeutic effects of temporary cardiac pacing as a rescue treatment in children with fulminant myocarditis,and to explore the indications for pacing and prognosis of these children. Methods:The clinical data of 23 children with fulminant myocarditis who received temporary cardiac pacing were retrospectively analyzed,and relevant literature was reviewed.Results:The development of fulminant myocarditis in the 23 children were characterized by acute onset,rapid progression,and occurrence of life-threatening malignant arrhythmias and acute hemodynamic disorders within a short term. All children survived to hospital discharge after installation of a temporary cardiac pacemaker on the basis of high-dose corticosteroids,gamma globulin,and other drugs,and 82.6% of the children regained sinus rhythm. Conclusion:When fulminant myocarditis is complicated by unsuccessful drug-treated severe arrhythmia or life-threatening acute hemodynamic disorders,timely temporary cardiac pacing is a safe and effective first-aid measure and is conducive to follow-up treatment.