蒋建刚.提高暴发性心肌炎的救治成功率，需要“早诊早治”[J].内科急危重症杂志,2022,28(6):441-443
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| DOI：10.11768/nkjwzzzz20220601 |
| 中文关键词: 暴发性心肌炎 免疫调节 机械循环支持 误诊误治 四个及早 |
| 英文关键词: |
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| 中文摘要: |
| 摘要 暴发性心肌炎是一类起病急骤、病情进展迅速的严重心脏炎症性疾病，临床表现为低血压或心源性休克、恶性心律失常甚至心脏猝死。早期，由于对暴发性心肌炎的认识不足,仅使用升血压、强心及免疫抑制治疗，导致其病死率居高不下,西方发达国家亦高于50%。而按照《成人暴发性心肌炎诊断与治疗中国专家共识》推荐的“以生命支持为依托的综合救治方案”(简称：中国方案），通过机械循环支持和免疫调节（足够剂量糖皮质激素和免疫球蛋白）为核心的治疗能将患者死亡率降低至5%以下。其中，机械循环支持就是让严重衰竭的心脏休息，而免疫调节则治疗炎症。中国方案强调:及早识别、及早诊断、及早预判和及早救治。尽管暴发性心肌炎的“中国方案”推行已久，但由于缺乏对暴发性心肌炎的警觉性，仍存在大量误诊、误治。因此，提升对暴发性心肌炎的警惕性，深刻认识四个及早，对于遏制暴发性心肌炎的进展，提高疗效和改善预后具有极为重要的意义。 |
| 英文摘要: |
| Abstract Fulminant myocarditis (FM) is a severe cardiac inflammatory disease with rapid onset and progression, characterized by hypotension, cardiogenic shock, malignant arrhythmia or even sudden cardiac death. Previously, due to lack of understanding of its pathophysiology, it was managed only by increasing blood pressure, cardiotonic and immunosuppressant, resulting in a persistently high case fatality rate, and it was also higher than 50% in Western developed countries. According to the "life support-based comprehensive treatment regimen" (referred to as the "Chinese regimen") recommended by the "Chinese Society of Cardiology Expert Consensus Statement on Adult Fulminant Myocarditis", treatments with mechanical circulatory support and immunomodulatory therapies (adequate doses of both glucocorticoids and immunoglobulin) as the core can reduce patient mortality to less than 5%. Among the regimens, mechanical circulatory support is to rest the severely exhausted heart, while immunological modulation can treat inflammation. The Chinese regimen emphasizes early identification, early diagnosis, early prediction and early treatment. Although the Chinese regimen of FM has been implemented for a long time, there are still a large number of misdiagnosis and mistreatment due to the lack of vigilance to FM. Therefore, to enhance the vigilance against FM and to have a deep understanding of the "four early" are of great significance for curbing the progress, improving the curative effect and prognosis of FM. |
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