兒童重癥病毒性心肌炎36例臨床特征及診治分析

楊 帆

[摘要] 目的 總結(jié)36例兒童重癥病毒性心肌炎﹙VM﹚的臨床特征及療效。方法 回顧性分析36例兒童重癥病毒性心肌炎的臨床資料。結(jié)果 病毒性心肌炎診斷缺乏典型臨床特征和特異性輔助檢查指標,常被基礎疾病癥狀掩蓋而導致延誤治療;本組36例兒童重癥病毒性心肌炎臨床癥狀重,30例均有明顯心臟癥狀,16例起病急驟,且伴有嚴重的合并癥,5例死亡,其中3例在24h內(nèi)死亡;心臟聽診異常、心電圖異常及早期心肌酶譜升高是最常見的檢查表現(xiàn);治療無特效手段,應注重綜合治療。結(jié)論 兒童病毒性心肌炎應結(jié)合病毒感染史,心悸、胸悶等臨床癥狀和心肌損害的客觀指標作出診斷;對重癥者應及時監(jiān)護和搶救,宜靜臥,中西醫(yī)結(jié)合,營養(yǎng)心肌、抗病毒、護肝和及時發(fā)現(xiàn)并防治并發(fā)癥。

[關(guān)鍵詞] 病毒;病毒性心肌炎;心肌酶譜;臨床特征

[中圖分類號] R551[文獻標識碼] A[文章編號] 1004-8650(2009)05-053-03

Analysis clinical feature and diagnosis and treatment of 36 children,s case with severe Viral myocarditis

Yang Fan

(Pediatric division,Affiliated Hospital of Medical School in Du An of Guangxi,530700,China)

[Abstract] Objective To summarize the clinical features and efficacy of 36 children patients of with severe viral myocarditis﹙VM).Methods To retrospective analysis clinical data in 36 children patients of with severe VM.Results Diagnosis of VM in the absence of typical clinical features and examination of specific targets,often conceal the basis of disease symptoms caused by delayed treatment;36 cases in this group of children with severe clinical symptoms of viral myocarditis weight,and there are 30 cases of cardiac symptoms, 16 cases from Disease sharp,and with serious complications,5 cases of death, of which three cases of death in 24h;cardiac auscultation abnormalities,ECG abnormalities and early myocardial enzyme rise is the most common inspection performance;the treatment of non-specific means should be focus on comprehensive treatment. Conclusion To diagnosis Viral myocarditis in children it should be combined with the history of virus infection, palpitations, chest tightness, and other clinical symptoms and objective indicators of myocardial damage.Treatment up to be supine,traditional Chinese and western medicine,nutrition,cardiac,anti-virus,security liver and to detect and control the complications。we should timely care and emergency treatment severe Viral myocarditis in children.

[Key words] Virus;Viral myocarditis;Cardiac muscle zymogram;Clinical feature

病毒性心肌炎(viral myocarditis,VM)是由各種病毒感染所引起的心肌急性或慢性炎癥,是兒科臨床常見病,輕型患兒無明顯臨床癥狀,僅心電圖可見過早搏動或T波降低改變,特別是嬰兒發(fā)病常不易被認識。而重癥患兒起病急驟,進展快,常伴多種并發(fā)癥,臨床表現(xiàn)復雜,易誤診誤治,可出現(xiàn)心源性休克或猝死,部分可轉(zhuǎn)化為擴張型心肌病(DCM)[1],應引起臨床重視。為尋求較為理想的診療方法,現(xiàn)將我院2005年12月-2009年1月收治的36例

兒童重癥病毒性心肌炎總結(jié)報道如下。

1資料與方法

1.1一般資料

2005年12月-2009年1月我科收治兒童病毒性心肌炎228例,其中重癥患者36例(16.8%),按2000年病毒性心肌炎診斷 (修訂草案)標準[2]確診。……