• 暴发性心肌炎处理:中国方案简便易行,疗效卓著,亟需推广
  • The consensus of Chinese experts on diagnosis and treatment of fulminant myocarditis and international advancement
  • 惠汝太.暴发性心肌炎处理:中国方案简便易行,疗效卓著,亟需推广[J].内科急危重症杂志,2022,28(1):1-10
    DOI:10.11768/nkjwzzzz20220101
    中文关键词:  暴发性心肌炎  诊断  循环辅助  激素  免疫调节
    英文关键词:
    基金项目:
    作者单位E-mail
    惠汝太 中国医学科学院阜外医院内科 国家心血管病中心 fuwaihui@163.com 
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    中文摘要:
          暴发性心肌炎仍然是医学界面临的一个严峻挑战,因为发病急骤,如不及时抢救,病死率非常高。经过多年的研究与实践,暴发性心肌炎的抢救成功率逐步提高(巨细胞心肌炎除外);但是,大多数患者仅仅能够及时到达县级医院,需要有一个我国县级医院能够实施的救治方案。华中科技大学同济医学院附属同济医院汪道文教授为首的团队,通过多年实践,组织全国专家撰写了暴发性心肌炎救治的中国方案。实践证明,符合中国的实际,抢救成功率达到95%以上。中国方案强调医生与患者保持暴发性心肌炎的警觉,及早发现,及时采取循环支持,激素与免疫调节剂为主的干预措施,稳定免疫紊乱导致的心脏与循环损害。近年来,国际上暴发性心肌炎在诊断与治疗方面均有较大进展,本文比较中国方案与国际方案的差异,就国际上有希望的研究、诊断与治疗进展作了简要介绍,抛砖引玉。
    英文摘要:
          Fulminant myocarditis(FM) is a sudden and severe diffuse cardiac inflammation, if left untreated, often leading to death resulting from cardiogenic shock, ventricular arrhythmias, or multiorgan failure. In recent years, the increasing availability of circulatory support such as IABP (intra-aortic balloon pump), ECMO(extracorporeal membrane oxygenation), orthotopic heart transplantation, and disease-specific treatments to maintain end-organ perfusion until transplantation or recovery, the clinic outcomes have been improved significantly. Unfortunately a lot of patients living in countryside as a result of a delay in diagnosis and initiation of circulatory support and lack of appropriately trained specialists to manage the condition. The consensus of Chinese experts on diagnosis and treatment of FM was outlined the resources necessary to manage FM, focus principally on an IABP, ECMO and early immunomodulatory therapies(such as corticosteroids). Corticosteroid therapy is not only for acute myocarditis (i.e., giant cell, eosinophilic and lymphocytic myocarditis) but also for those affected by sarcoidosis or systemic autoimmune disorders. Education of frontline providers who are most likely to encounter FM first is essential to increase timely access to appropriately resourced facilities, to prevent multiorgan failure, and to tailor disease-specific therapy as early as possible in the disease process. It does not have to wait endomyocardial biopsy. In order to provide a rational for future individual-based treatment of patients affected by FM with distinct etiologies and pathophysiological pathways,further research is mandatory to identify factors and mechanisms that may trigger/maintain or counteract/repair the myocardial damage, to test their effectiveness.