CAJ | 학술논문

目的：探讨儿童暴发性心肌炎的临床特征。方法对北京儿童医院2007年1月至2013年5月收治的50例暴发性心肌炎患儿的病历资料进行回顾性分析，对其性别、年龄、临床表现及治疗、预后等进行总结。结果50例暴发性心肌炎患儿中，存在消化道症状16例（32．0％），心血管系统症状14例（28．0％），神经系统症状8例（16．0％），26．0％（13例）的患儿以阿斯综合征为首发表现，46例（92．0％）存在心电图异常表现，心肌酶指标及心脏彩色多普勒超声阳性率分别为48．0％（24例）和50．0％（25例）；32例给予丙种球蛋白输注，44例应用甲泼尼龙，28例Ⅲ度房室传导阻滞患儿在综合治疗基础上安装临时起搏器，4例患儿最终安装永久起搏器；对发生室性心动过速的20例患儿，6例应用利多卡因，7例应用胺碘酮进行转复，8例给予同步电复律，17例心动过速终止，1例安装临时起搏器后转复窦性心律，2例合并心室颤动的患儿经抢救无效死亡。结论儿童暴发性心肌炎的症状多样，多数不典型，误诊、漏诊率高；联合心电图、心脏彩色多普勒超声及心肌酶学指标诊断暴发性心肌炎的阳性率高，并对疾病的严重程度、预后有一定的提示作用。
목적：탐토인동폭발성심기염적림상특정。방법대북경인동의원2007년1월지2013년5월수치적50례폭발성심기염환인적병력자료진행회고성분석，대기성별、년령、림상표현급치료、예후등진행총결。결과50례폭발성심기염환인중，존재소화도증상16례（32．0％），심혈관계통증상14례（28．0％），신경계통증상8례（16．0％），26．0％（13례）적환인이아사종합정위수발표현，46례（92．0％）존재심전도이상표현，심기매지표급심장채색다보륵초성양성솔분별위48．0％（24례）화50．0％（25례）；32례급여병충구단백수주，44례응용갑발니룡，28례Ⅲ도방실전도조체환인재종합치료기출상안장림시기박기，4례환인최종안장영구기박기；대발생실성심동과속적20례환인，6례응용리다잡인，7례응용알전동진행전복，8례급여동보전복률，17례심동과속종지，1례안장림시기박기후전복두성심률，2례합병심실전동적환인경창구무효사망。결론인동폭발성심기염적증상다양，다수불전형，오진、루진솔고；연합심전도、심장채색다보륵초성급심기매학지표진단폭발성심기염적양성솔고，병대질병적엄중정도、예후유일정적제시작용。
Objective To investigate clinical characteristics of children with fulminant myocarditis . Methods The 50 cases of fulminant myocarditis were retrospectively analyzed .The children′s gender, age, clini-cal manifestations , treatment and prognosis were summarized .Results Among fifty cases of fulminant myocarditis in children,16 cases(32.0%) had digestive tract symptoms, 14 cases (28.0%) had cardiovascular symptom, 8 cases (16.0%) had nervous system symptoms .Asperger syndrome was the primary symptom in 26.0%of chil-dren;46 cases (92.0%) had abnormal electrocardiogram;positive rate of myocardial enzyme index and heart col-or doppler flow imaging were 48.0%(24 cases) and 50.0%(25 cases);32 cases were given immunoglobulin in-fusion;44 cases had prednisolone; 28 cases with Ⅲ degree atrioventricular block had temporary pacemaker in-stalled based on the comprehensive treatment .4 cases were given final permanent pacemaker installation .6 cases had lidocaine;7 cases had amiodarone;8 cases were given synchronous cardioerter .17 tachycardia was termina-ted;one case had temporary pacemaker installed after converting sinus rhythm;2 cases with ventricular fibrillation died.Conclusions Most of children with fulminant myocarditis have diverse symptoms and most are not typical ;misdiagnosis rate is high .Comprehensive analysis of the results of electrocardiogram ,echocardiography and myocar-dial enzymology markers may improve the diagnosis of fulminant myocarditis and may also indicate the severity and prognosis.