儿童暴发性心肌炎28例的描述性研究

Fulminant myocarditis in children:a descriptive study of 28 cases in a single center

目的总结分析儿童暴发性心肌炎(fulminant myocarditis,FM)的临床特点、诊治策略及疗效。方法回顾性分析2014年7月至2019年12月青岛市妇女儿童医院收治的FM患儿的临床资料,包括一般资料、临床症状及体征、辅助检查、治疗、并发症及预后等。结果 28例FM患儿中,男11例,女17例,平均年龄(67.13±44.54)个月,最大156个月,最小4个月3 d,早期临床表现呈多样性且无特异性。就诊时15例(53.6%)发生心源性休克,10例(35.7%)急性心力衰竭,6例(21.4%)阿斯发作。27例患儿中,入院第1天22例肌酸激酶同工酶升高,18例肌钙蛋白I升高,存活者心肌标志物的水平均随治疗而逐渐下降(P<0.05);28例患儿中入院时21例出现心律失常,其中致命性快速性心律失常11例,致命性缓慢性心律失常7例,治疗过程中心电图呈现多样性变化。6例置入临时起搏器,5例ECMO治疗,21例予人免疫球蛋白,17例予大剂量甲泼尼龙,死亡9例。结论 FM常以心外症状为首发表现,心肌标志物、心电图、超声心动图等对及时正确诊断尤为重要;一旦确诊,及时给予包括药物治疗和(或)机械辅助治疗在内的措施,维持血流动力学稳定是提高本病存活率的关键。

Objective:To analyze the clinical characteristics,diagnosis and treatment of fulminant myocarditis(FM)in children.Methods:The data of FM children hospitalized at Qingdao Women and Children′s Hospital from Jul.2014 to Dec.2019 were analyzed retrospectively,including general data,symptoms,signs,auxiliary examination,treatment,complications and prognosis,etc.Results:Twenty-eight children with FM,of whom eleven were male and seventeen were female,aged from 4 months and 3 days to 156 months,the averaged age was(67.13±44.54)months.The early clinical manifestations were various and nonspecific.In admission,cardiac shock and acute heart failure developed in fifteen cases(53.6%)and ten cases(35.7%),respectively,and Adams-Stoke developed in six cases(21.4%).Serum CK-MB levels and serum cTnI levels increased in twenty-two cases and eighteen cases,respectively,and decreased after effective treatment(P<0.05).Electrocardiograms of twenty-eight children were abnormal in admission,meanwhile various arrhythmia was detected in twenty-one children including eleven cases with fatal tachyarrhythmia and seven cases with fatal bradyarrhythmia,and changed dynamically during treatment.Six children were treated with temporary cardiac pacemaker and five cases with extracorporeal membranous oxygenation.Twenty-one cases were given large dose of intravenous immunoglobulin and seventeen cases with large dose of methylprednisolone.The mortality rate was 32.1%(9/28).Conclusion:The early clinical manifestations of FM are non-cardiac symptom with nonspecific characteristics.Cardiac markers,electrocardiogram,echocardiography are all important for diagnosis of FM.Once diagnosed,maintaining hemodynamic stability by pharmacotherapy and/or mechanotherapy is crucial to improve survival rate.