中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2015年
1期
24-28
,共5页
谢剑昶%来蕾%徐鹏%朱钢杰%孙丽娜%王宁夫
謝劍昶%來蕾%徐鵬%硃鋼傑%孫麗娜%王寧伕
사검창%래뢰%서붕%주강걸%손려나%왕저부
心肌炎%诊断%临床特点
心肌炎%診斷%臨床特點
심기염%진단%림상특점
Myocarditis%Clinical feature%Diagnosis
目的 探讨暴发型心肌炎的临床特点,为临床诊治提供参考.方法 回顾分析我院2005年1月至2012年12月间诊断病毒性心肌炎患者183例的资料,对其中153例急性心肌炎(急性心肌炎组)和30例暴发型心肌炎(暴发型心肌炎组)的临床特点、发病年龄、症状、实验室及辅助检查、治疗方式及转归等进行比较.结果 暴发型心肌炎组与急性心肌炎组患者平均年龄相似[(22.3±7.6)岁比(26.2±12.6)岁,P=0.105 5],有明确的前驱感染症状的患者比例[30.0％(9/30)比78.4％(120/153),x2=28.3,P＜0.001]、平均潜伏时间[(3.1±2.2)d比(7.0±3.8)d,P＜0.001]、平均住院时间[(12.1±6.9)d比(6.9±4.5)d,P＜0.001]比较差异均有统计学意义.急性心肌炎组的起病症状以胸闷(101/153,66.0％)、乏力(76/153,49.7％)、心慌(74/153,48.4％)为主,而暴发型心肌炎组的起病症状以胸闷(24/30,80.0％)、气急(14/30,46.7％)、乏力(13/30,43.3％)为主.暴发型心肌炎组主要并发症有高度房室传导阻滞(19/30,63.3％)、心源性休克(18/30,60.0％)、室性心律失常(16/30,53.3％)、阿斯综合征(8/30,26.7％)、急性肾衰竭(8/30,26.7％)等;其中有11例患者植入临时起搏器,7例患者使用体外膜肺氧合(ECMO),7例患者植入主动脉内球囊反搏(IABP)辅助;住院期间21例治愈,9例(30.0％)死亡,出院后1例植入永久起搏器,1例转变为慢性心肌炎反复住院.结论 暴发型心肌炎起病急骤,多缺少典型前驱症状或前驱感染期,潜伏时间较普通急性心肌炎短.及时有效的器械辅助治疗对暴发型心肌炎抢救和预后有积极作用.
目的 探討暴髮型心肌炎的臨床特點,為臨床診治提供參攷.方法 迴顧分析我院2005年1月至2012年12月間診斷病毒性心肌炎患者183例的資料,對其中153例急性心肌炎(急性心肌炎組)和30例暴髮型心肌炎(暴髮型心肌炎組)的臨床特點、髮病年齡、癥狀、實驗室及輔助檢查、治療方式及轉歸等進行比較.結果 暴髮型心肌炎組與急性心肌炎組患者平均年齡相似[(22.3±7.6)歲比(26.2±12.6)歲,P=0.105 5],有明確的前驅感染癥狀的患者比例[30.0％(9/30)比78.4％(120/153),x2=28.3,P＜0.001]、平均潛伏時間[(3.1±2.2)d比(7.0±3.8)d,P＜0.001]、平均住院時間[(12.1±6.9)d比(6.9±4.5)d,P＜0.001]比較差異均有統計學意義.急性心肌炎組的起病癥狀以胸悶(101/153,66.0％)、乏力(76/153,49.7％)、心慌(74/153,48.4％)為主,而暴髮型心肌炎組的起病癥狀以胸悶(24/30,80.0％)、氣急(14/30,46.7％)、乏力(13/30,43.3％)為主.暴髮型心肌炎組主要併髮癥有高度房室傳導阻滯(19/30,63.3％)、心源性休剋(18/30,60.0％)、室性心律失常(16/30,53.3％)、阿斯綜閤徵(8/30,26.7％)、急性腎衰竭(8/30,26.7％)等;其中有11例患者植入臨時起搏器,7例患者使用體外膜肺氧閤(ECMO),7例患者植入主動脈內毬囊反搏(IABP)輔助;住院期間21例治愈,9例(30.0％)死亡,齣院後1例植入永久起搏器,1例轉變為慢性心肌炎反複住院.結論 暴髮型心肌炎起病急驟,多缺少典型前驅癥狀或前驅感染期,潛伏時間較普通急性心肌炎短.及時有效的器械輔助治療對暴髮型心肌炎搶救和預後有積極作用.
목적 탐토폭발형심기염적림상특점,위림상진치제공삼고.방법 회고분석아원2005년1월지2012년12월간진단병독성심기염환자183례적자료,대기중153례급성심기염(급성심기염조)화30례폭발형심기염(폭발형심기염조)적림상특점、발병년령、증상、실험실급보조검사、치료방식급전귀등진행비교.결과 폭발형심기염조여급성심기염조환자평균년령상사[(22.3±7.6)세비(26.2±12.6)세,P=0.105 5],유명학적전구감염증상적환자비례[30.0％(9/30)비78.4％(120/153),x2=28.3,P＜0.001]、평균잠복시간[(3.1±2.2)d비(7.0±3.8)d,P＜0.001]、평균주원시간[(12.1±6.9)d비(6.9±4.5)d,P＜0.001]비교차이균유통계학의의.급성심기염조적기병증상이흉민(101/153,66.0％)、핍력(76/153,49.7％)、심황(74/153,48.4％)위주,이폭발형심기염조적기병증상이흉민(24/30,80.0％)、기급(14/30,46.7％)、핍력(13/30,43.3％)위주.폭발형심기염조주요병발증유고도방실전도조체(19/30,63.3％)、심원성휴극(18/30,60.0％)、실성심률실상(16/30,53.3％)、아사종합정(8/30,26.7％)、급성신쇠갈(8/30,26.7％)등;기중유11례환자식입림시기박기,7례환자사용체외막폐양합(ECMO),7례환자식입주동맥내구낭반박(IABP)보조;주원기간21례치유,9례(30.0％)사망,출원후1례식입영구기박기,1례전변위만성심기염반복주원.결론 폭발형심기염기병급취,다결소전형전구증상혹전구감염기,잠복시간교보통급성심기염단.급시유효적기계보조치료대폭발형심기염창구화예후유적겁작용.
Objective To review the clinical features of fulminant myocartitis,in order to provide assistance to the clinical management.Methods The clinic data of 183 patients with viral myocarditis,including 153 cases of acute myocarditis and 30 cases of fulminant myocarditis admitted in our hospital during January 2008 and Dec 2012 were retrospectively analyzed.The age of onset,interval after virus infect,initial symptoms,auxiliary examination,treatment,and turnover were compared in the study.Results The average onset age of fulminant myocartitis and acute myocarditis were similar [(22.3 ± 7.6) vs.(26.2 ± 12.6) years,P =0.105 5].There was a significant difference between the two gourps in the rate of patients with a explicit history of virus infection [30.0％ (9/30) vs.78.4％ (120/153),x2 =28.3,P ＜0.001],the average interval after virus infect [(3.1 ±2.2) vs.(7.0 ±3.80) d,P＜0.001] and the length of hospital stay [(12.1 ± 6.9) vs.(6.9 ± 4.50) d,P ＜ 0.001].Chest congestion (101/153,66.0％),feebleness (76/153,49.7％),fluster (74/153,48.4％) are the most onset symptoms of acute myocarditis,while chest congestion (24/30,80.0％),shortness of breath (14/30,46.7％),feebleness (13/30,43.3％) in flunimant myocarditis.Advanced A-V block (19/30,63.3％),cardiogenic shock (18/30,60.0％),ventricular arrhythmia(16/30,53.3％),Adams-Stokes syndrome(8/30,26.67％) and acute renal failure (8/30,26.7％) were the most complications of flunimant myocarditis.Temporary pacemaker (11 cases),extracorporeal memberane exygenator (7 cases) and intra-aortic balloon pump (7 cases) were applied in critical patients.In acute phase,21 cases were cured,9 cases was dead of cardiogenic shock and ventricular(27,30.0％).Two dead cases applied with ECMO because of delay.After leaving hospital,1 case was implanted permanent pacemaker,2 cases became chronic myocarditis and required hospitalization repeatedly.Conclusions The fulminant myocarditis has a rapid onset,most of which has no prodrome of virus infection or a shorter interval than acute myocarditis.Timely and effective mechanical circulatory support is critical for fulminant myocarditis.
