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目的探讨小儿暴发性心肌炎的临床特点及诊治方法。方法对2003年8月-2007年7月南京医科大学附属南京市儿童医院收治并确诊的21例暴发性心肌炎患儿的临床资料进行回顾性分析。男9例,女12例;年龄0.5~8.0岁。均符合病毒性心肌炎诊断标准,排除先天性或风湿性等其他心脏疾病。分别表现为急性心功能不全、心源性休克、心脑综合征等。患儿入院后均予大剂量肾上腺皮质激素、静脉应用丙种球蛋白、抗病毒等综合治疗。结果暴发性心肌炎21例患儿心电图和酶学检查均异常。超声心动图示心脏扩大17例。X线胸片示心影增大14例。患儿经综合治疗后18例好转,CK-MB降至正常,出院时及出院后1.5个月检查心脏大小恢复正常。3例死亡。结论暴发性心肌炎可致命,如能早期诊断、及时静脉应用丙种球蛋白、大剂量肾上腺皮质激素,预后较好。若出现心脑综合征,安置临时起搏器可帮助患儿度过急性期。
Objective To investigate the clinical features and diagnosis and treatment of fulminant myocarditis in children. Methods The clinical data of 21 patients with fulminant myocarditis admitted to Nanjing Children’s Hospital affiliated to Nanjing Medical University from August 2003 to July 2007 were analyzed retrospectively. 9 males and 12 females; aged from 0.5 to 8.0 years old. All meet the diagnostic criteria of viral myocarditis, excluding congenital or rheumatic heart disease and other. Respectively showed acute heart failure, cardiogenic shock, heart and brain syndrome. Children admitted to high-dose adrenal cortex hormones, intravenous gamma globulin, anti-virus and other comprehensive treatment. Results 21 cases of fulminant myocarditis electrocardiogram and enzyme examination were abnormal. Echocardiography showed heart enlargement in 17 cases. X-ray showed cardiac shadow increased in 14 cases. 18 cases of children improved after treatment, CK-MB dropped to normal, 1.5 months after discharge from the hospital and check the heart size returned to normal. 3 died. Conclusions Fulminant myocarditis can be fatal. If early diagnosis and timely intravenous administration of gamma globulin and high dose of adrenocorticotropic hormone, the prognosis is good. If there is heart and brain syndrome, placement of temporary pacemaker can help children through the acute phase.