张敏.17例儿童暴发性心肌炎的临床特点及诊治经验[J].内科急危重症杂志,2021,27(5):372-376
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| DOI：10.11768/nkjwzzzz20210505 |
| 中文关键词: 暴发性心肌炎 儿童 以生命支持为依托的综合救治方案 糖皮质激素 静脉免疫球蛋白 神经氨酸酶抑制剂 |
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| 中文摘要: |
| 目的： 总结儿童暴发性心肌炎（FM）的临床特点、诊治方法及疗效。 方法：回顾性分析2013年1月至2020年12月华中科技大学同济医学院附属武汉儿童医院收治的17例FM患儿的临床资料，包括一般资料、临床表现、辅助检查、治疗、并发症及预后等。结果：17例FM患儿中，男性8例，女性9例， 年龄1～12岁4月，中位数年龄5.9岁；病程初期患儿常表现为消化道和呼吸道症状，就诊时10例发生心原性休克，9例发生心力衰竭，3例发生阿斯综合征，3例发生室性心动过速。17例患儿中，入院第1天15例（88.2%）血清肌酸激酶同工酶（CK-MB）水平升高，12例（70.6%）血清超敏肌钙蛋白T（hs-cTnT）水平升高，11例（64.7%）血浆N末端B型脑钠肽（NT-proBNP）水平升高。17例患儿中5例置入临时起搏器，1例予体外膜肺氧合(ECMO)治疗。14例患儿予静脉免疫球蛋白，其中13例患儿予以足剂量糖皮质激素治疗。本组共治愈9例，治疗好转后要求出院3例，2例患儿于入院当天要求出院并且外院继续治疗（1例在外院心脏移植，1例在外院治疗痊愈），死亡3例。结论：FM患儿治愈率及好转率均较成人FM患者低，常以消化道和呼吸道症状为首发表现，表现形式多样，漏诊及误诊率较高，早期识别、积极治疗FM患儿极为重要。 |
| 英文摘要: |
| Objective: To explore the clinical characteristics, diagnosis and treatment of fulminant myocarditis (FM) in children. Methods: The data of 17 children with FM hospitalized in Wuhan Children's Hospital from January 2013 to December 2020 were analyzed retrospectively, including general data, clinical manifestations, auxiliary examination, complication and prognosis. Results: Of 17 children with FM, there were 8 boys and 9 girls, aged from 1 year to 12 years and 4 months. The median age was 5.9 years. The clinical manifestations included gastrointestinal and respiratory symptoms in the early stage of the disease. At admission, cardiac shock occurred in 10 cases, acute heart failure in 9 cases, Adams Stoke in 3 cases and ventricular tachycardia in 3 cases. Among the 17 cases, serum CK-MB levels and serum high-sensitivity troponin T (hs-cTnT) levels increased in 15 cases (88.2%) and 12 cases (70.6%), respectively, as well as 11 cases (64.7%) had elevated N-terminal pro-natriuretic peptide (NT-proBNP) on the first day of admission. There were 5 children who were implanted with temporary pacemaker, 1 case was treated with ECMO, 14 cases were treated with intravenous immunoglobulin, and 13 cases were treated with full dose of glucocorticoid. In this study, 9 cases were cured, 3 cases were required to be discharged after improvement, and 2 cases were discharged immediately on the day of admission in our hospital and continued to be treated in other hospitals (1 case received heart transplantation in the other hospital, 1 case was cured in the other hospital), 3 cases died. Conclusion: The cure rate and improvement rate of children with FM were lower than those of adult patients with FM. Digestive and respiratory symptoms were the first manifestations of FM with various clinical manifestations, which led to high rate of missed diagnosis and misdiagnosis. Therefore, early identification and active treatment are very important for the diagnosis and treatment of FM. |
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