ISSN 1674-3865  CN 21-1569/R
主管：国家卫生健康委员会
主办：中国医师协会
　　　辽宁省基础医学研究所
　　　辽宁中医药大学附属医院
中国中西医结合儿科学

中国中西医结合儿科学 ›› 2016, Vol. 8 ›› Issue (2): 171-174.doi: 10.3969/j.issn.1674-3865.2016.02.015

• 临床研究 • 上一篇    下一篇

以消化道症状首发的暴发性心肌炎患儿10例临床特征及预后分析

于亚杰   

  1. 122000 辽宁 朝阳，朝阳市第二医院儿科
  • 出版日期:2016-04-25 发布日期:2018-11-19
  • 作者简介:于亚杰(1975-)，女，副主任医师。研究方向：小儿消化内科疾病的诊治，E-mail：liuseshamo@163.com

Analysis of the clinical features and prognosis of 10 children with fulminant myocarditis manifested first with digestive symptoms

YU Yajie   

  1. The Second Hospital of Chaoyang，Chaoyang 122000，China.
  • Online:2016-04-25 Published:2018-11-19

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摘要：
目的：总结以消化道症状首发的暴发性心肌炎的临床特征、治疗及预后。
方法：2004年8月至2014年8月朝阳市第二医院儿科收治以消化道症状首发的暴发性心肌炎患儿10例。患儿出现心力衰竭、心源性休克给予呼吸机辅助呼吸治疗，多巴胺及多巴酚丁胺持续静脉滴注，001%肾上腺素强心、胺碘酮复律、胸外心脏按压等抢救治疗。进行血常规、心肌酶谱、肌钙蛋白、血糖、心电图等相关检查。
结果：6例死亡，3例好转，1例治愈。6例急性期死亡患儿均在入院后48 h内死亡，均有不同程度的心源性休克、心力衰竭、致死性心律失常等。
结论：以消化道症状首发的暴发性心肌炎的临床特征不具有特异性，极易漏诊、误诊为小儿消化系统疾病，延误最佳治疗时机，早期明确诊断，及时纠正休克，改善心功能，尽快给予积极治疗能明显降低病死率，改善预后。

关键词: 暴发性心肌炎, 消化道症状, 心源性休克, 机械支持治疗, 儿童

Abstract:
Objective:To summarize the clinical features,treatment and prognosis of fulminant myocarditis manifested first with digestive symptoms.
Methods:Ten children with fulminant myocarditis manifested first with digestive symptoms were admitted to the Second Hospital of Chaoyang from Aug.2004 to Aug.2014.The children had heart failure and cardiac shock.They were given breathing machine for assistant breathing,intravenous dripping with dopamine and dobutamine,001% adrenaline to strengthen heart,amiodarone to revert cardiac rhythm,and closed chest compression.Myocardial enzymes,troponin and blood glucose were determined,and blood routine test and electrocardiography were performed.
Results:There were 6 cases of death,3 improved and one cured.The 6 death cases were dead in 48 h of admission to the hospital,with different degrees of cardiac shock,heart failure and arrhythmia,etc.
Conclusion:The clinical features of fulminant myocarditis manifested first with digestive symptoms are not specific,which are likely to be missed in diagnosis or misdiagnosed as pediatric digestive diseases,and the best time for treatment is missed.Early diagnosis,timely correction of shock,improving cardiac function and performing positive treatment immediately can significantly reduce the mortality and improve the prognosis.

Key words: Fulminant myocarditis, Digestive tract symptoms, Cardiac shock, Mechanical support treatment, Children