中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
5期
296-299
,共4页
夏天和%吴蓉洲%张园海%陈其%项如莲
夏天和%吳蓉洲%張園海%陳其%項如蓮
하천화%오용주%장완해%진기%항여련
重症心肌炎%诊断%治疗%儿童
重癥心肌炎%診斷%治療%兒童
중증심기염%진단%치료%인동
Severe viral myocarditis%Diagnosis%Treatment%Children
目的 探讨儿童重症心肌炎临床特点及治疗方法.方法 对我院2005年1月至2012年1月收治的19例儿童重症心肌炎(重症心肌炎组)发病特点、临床表现、诊治经过及预后进行回顾性分析,选择同期在我院体检的正常健康儿童23例为对照组.采用ELISA法检测心肌肌钙蛋白(cardiac troponin,CTn)-Ⅰ及血清氨基末端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平,应用彩色多普勒超声心动图检查了解左室射血分数和左室短轴缩短率变化.结果 重症心肌炎组患儿CTn-Ⅰ为(18.67 ±12.31) ng/ml,显著高于正常对照组[(0.02 ±0.01) ng/ml],差异有统计学意义(P＜0.05).与急性期相比,病程第7天CTn-Ⅰ为(0.55±0.24) ng/ml,呈逐渐下降趋势,第14天基本接近正常[(0.06±0.03) ng/ml],差异有统计学意义(P＜0.05).重症心肌炎组NT-proBNP较对照组明显增高[(3 067.26 ±902.79) pg/ml vs (80.04±17.79) pg/ml,P＜0.05].与急性期相比,病程第7天NT-proBNP为(648.63±342.37) pg/ml,病程第14天基本接近正常[(213.58±129.51) pg/ml](P＜0.05).重症心肌炎组患儿左室射血分数[(52.63±6.98)％vs(71.39±2.41)％]及左室短轴缩短率[(32.1±2.97)％vs(40.04±2.31)％]明显低于正常对照组,差异均有统计学意义(P均＜0.05).结论 儿童重症心肌炎起病急,病情重,病死率高,在综合治疗基础上早期应用肾上腺素皮质激素和丙种球蛋白,必要时安装临时起搏器,可改善预后.
目的 探討兒童重癥心肌炎臨床特點及治療方法.方法 對我院2005年1月至2012年1月收治的19例兒童重癥心肌炎(重癥心肌炎組)髮病特點、臨床錶現、診治經過及預後進行迴顧性分析,選擇同期在我院體檢的正常健康兒童23例為對照組.採用ELISA法檢測心肌肌鈣蛋白(cardiac troponin,CTn)-Ⅰ及血清氨基末耑腦利鈉肽前體(N-terminal pro-brain natriuretic peptide,NT-proBNP)水平,應用綵色多普勒超聲心動圖檢查瞭解左室射血分數和左室短軸縮短率變化.結果 重癥心肌炎組患兒CTn-Ⅰ為(18.67 ±12.31) ng/ml,顯著高于正常對照組[(0.02 ±0.01) ng/ml],差異有統計學意義(P＜0.05).與急性期相比,病程第7天CTn-Ⅰ為(0.55±0.24) ng/ml,呈逐漸下降趨勢,第14天基本接近正常[(0.06±0.03) ng/ml],差異有統計學意義(P＜0.05).重癥心肌炎組NT-proBNP較對照組明顯增高[(3 067.26 ±902.79) pg/ml vs (80.04±17.79) pg/ml,P＜0.05].與急性期相比,病程第7天NT-proBNP為(648.63±342.37) pg/ml,病程第14天基本接近正常[(213.58±129.51) pg/ml](P＜0.05).重癥心肌炎組患兒左室射血分數[(52.63±6.98)％vs(71.39±2.41)％]及左室短軸縮短率[(32.1±2.97)％vs(40.04±2.31)％]明顯低于正常對照組,差異均有統計學意義(P均＜0.05).結論 兒童重癥心肌炎起病急,病情重,病死率高,在綜閤治療基礎上早期應用腎上腺素皮質激素和丙種毬蛋白,必要時安裝臨時起搏器,可改善預後.
목적 탐토인동중증심기염림상특점급치료방법.방법 대아원2005년1월지2012년1월수치적19례인동중증심기염(중증심기염조)발병특점、림상표현、진치경과급예후진행회고성분석,선택동기재아원체검적정상건강인동23례위대조조.채용ELISA법검측심기기개단백(cardiac troponin,CTn)-Ⅰ급혈청안기말단뇌리납태전체(N-terminal pro-brain natriuretic peptide,NT-proBNP)수평,응용채색다보륵초성심동도검사료해좌실사혈분수화좌실단축축단솔변화.결과 중증심기염조환인CTn-Ⅰ위(18.67 ±12.31) ng/ml,현저고우정상대조조[(0.02 ±0.01) ng/ml],차이유통계학의의(P＜0.05).여급성기상비,병정제7천CTn-Ⅰ위(0.55±0.24) ng/ml,정축점하강추세,제14천기본접근정상[(0.06±0.03) ng/ml],차이유통계학의의(P＜0.05).중증심기염조NT-proBNP교대조조명현증고[(3 067.26 ±902.79) pg/ml vs (80.04±17.79) pg/ml,P＜0.05].여급성기상비,병정제7천NT-proBNP위(648.63±342.37) pg/ml,병정제14천기본접근정상[(213.58±129.51) pg/ml](P＜0.05).중증심기염조환인좌실사혈분수[(52.63±6.98)％vs(71.39±2.41)％]급좌실단축축단솔[(32.1±2.97)％vs(40.04±2.31)％]명현저우정상대조조,차이균유통계학의의(P균＜0.05).결론 인동중증심기염기병급,병정중,병사솔고,재종합치료기출상조기응용신상선소피질격소화병충구단백,필요시안장림시기박기,가개선예후.
Objective To explore the clinical features and treatment of children with acute severe viral myocarditis.Methods The clinical data of presentation,diagnosis,therapy and prognosis of children who were admitted in our hospital from Jan 2005 to Jan 2012 with acute severe viral myocarditis(severe myocarditis group) were analyzed retrospectively.Twenty-three cases of normal healthy children in the same period were selected as control group.The levels of serum cardiac troponin(CTn)-Ⅰ and N-terminal pro-brain natriuretic peptide(NT-proBNP) were detected by ELISA method,the changes of left ventricular ejection fraction and left ventricular fraction shortening were understood by color doppler echocardiography.Results The level of CTn-Ⅰin severe myocarditis group was significantly higher than that of control group,the difference was statistically significant [(18.67 ± 12.31) ng/ml vs (0.02 ±0.01) ng/ml,P ＜0.05].Compared with the acute phase,the level of CTn-Ⅰshowed a trend of gradual decline in 7 d [(0.55 ±0.24) ng/ml],basic close to normal in 14 d [(0.06 ±0.03) ng/ml] (P ＜0.05).The level of NT-proBNP increased significantly in severe myocarditis group compared with control group [(3 067.26 ± 902.79) pg/ml vs (80.04 ± 17.79) pg/ml,P ＜0.05].Compared with acute phase,the levels of NT-proBNP were closed to normal in 7 d [(648.63 ±342.37) pg/ml] and 14 d [(213.58 ± 129.51) pg/ml] (P ＜ 0.05).The left ventricular ejection fraction [(52.63 ± 6.98) ％ vs (71.39 ± 2.41) ％] and left ventricular fraction shortening [(32.1 ± 2.97) ％ vs (40.04 ± 2.31) ％] in severe myocarditis group were significantly lower than those in control group (P ＜ 0.05).Conclusion Acute severe viral myocarditis of children was characterized by rapid onset,severe illness and high mortality.Early use of adrenal cortical hormone and gamma globulin under the comprehensive treatment and application temporary pacemaker can help patients to recover from the disease.
