儿童暴发性心肌炎机械循环支持治疗进展

Advances in mechanical circulatory support therapy for fulminant myocarditis in children

儿童暴发性心肌炎常有短暂的病毒感染前驱症状,起病急,早期缺乏特异性的临床表现,易迅速进展为严重的心脏泵功能障碍及心律失常,导致心源性体克甚至心源性猝死.部分患儿即使给予大剂量正性肌力药物、糖皮质激素、静脉丙种球蛋白及抗心律失常药物等治疗,以及给予机械通气、临时起搏器等其他治疗,仍不能改循环衰竭,最终出现不可逆的心脏损害,危及生命.有报道表明,若能及时对危重症患儿应用机械循环支持,可有效促进心脏泵功能恢复、降低病死率及改善预后.机械循环装置主要包括体外膜肺氧合、主动脉内球囊反搏术、左心室辅助装置或双心室辅助装置等.鉴于国内儿科领域对该技术认识有限,目前尚未得到广泛的应用,该文就儿童暴发性心肌炎应用机械循环支持治疗进展进行综述.

Fulminant myocarditis in children often has a transient viral prodrome,which is characterized by acute onset and lack of specificity in the early stage.It is prone to deteriorate in serious cardiac pump dysfunction and arrhythmia,which may lead to cardiogenic shock and even sudden cardiac death.Some patients are given the pharmacologic treatment of large doses of inotropes,corticosteroids,intravenous immunoglobulin,antiarrhythmic agents as well as other therapies such as mechanical ventilation,temporary pacemaker,but the circulatory failure still can not be improved,leading to irreversible heart damage and life-threatening.It has been reported that timely mechanical circulatory support for critically ill children can effectively promote the recovery of cardiac pump function,reduce mortality and improve prognosis.Mechanical circulatory assist devices mainly inclucle extracorporeal membrane oxygenation(ECMO),intra aortic balloon pump (IABP),left ventricular assist device (LVAD) or double ventricular assist device(Bi-VAD).In view of the limited understanding of the technology in the field of pediatrics in our country,this has not been used extensively.This article reviews the progress of FM treatment in children with mechanical circulatory support.