目的:通过对儿童急性暴发性心肌炎的临床表现、实验室指标、抢救治疗和转归进行回顾性分析研究,探讨小儿暴发性心肌炎的临床特点及有效安全的救治方法。方法:收集并分析2008年1月-2012年12月四川大学华西第二医院符合纳入标准的急性暴发性心肌炎16例,回顾性分析临床表现、心电图、心脏B超、血清生化指标、抢救治疗方法及预后,并总结其诊断和抢救治疗的特点。结果:16例暴发性心肌炎以学龄期儿童为主,平均年龄(7.19±4.69)岁,入院时有消化道症状表现者10例(62.5%),有呼吸道症状表现者7例(43.75%),有循环灌注不足表现者10例(62.5%),有心脏症状(心悸、胸痛)表现者6例(37.5%),其中8例伴发热(50%)。16例暴发性心肌炎患儿入院时X线胸片9例异常表现(56.25%),其中心影增大3例,肺水肿/充血5例,胸腔积液6例;超声心动图检查8例有异常表现(50%),平均射血分数(EF)为(50±15)%,平均缩短分数(FS)为(29±15)%,左心室增大5例,左室收缩功能下降4例,瓣膜反流4例,心包积液3例;心电图均有不同程度异常表现(100%),其中Ⅲ度阻滞8例(50%);肌钙蛋白升高者15例(93.75%)。抢救治疗过程中,15例使用甲强龙冲击治疗(93.75%),11例使用丙种球蛋白冲击治疗(68.75%),8例安置临时起搏器(50%),5例行呼吸机支持(31.25%),4例行血液净化治疗(25%)。其中6例于急性期死亡(37.5%),平均住院日5.3天,10例存活并好转出院,平均住院日26.5天,出院1月门诊随访,患者心肌酶、肝肾功能正常,超声心动图恢复正常,2例有继发性癫痫后遗症并长期口服抗癫痫药物。16例暴发性心肌炎中,9例合并多器官功能障碍综合征(56.25%),其中4例重症多器官功能衰竭患儿予以呼吸机辅助通气、安置临时起搏器并连续性血液净化联合治疗,3例存活,1例死亡。结论:暴发性心肌炎起病急,病情重,起病初期多以心外症状为主,易误诊漏诊,急性期死亡率高,对疑诊病例应行心电图、超声心动图、胸片检查并综合判断。一旦确诊需早期予抗心力衰竭,心源性休克,抗心律失常治疗。 Objective: To retrospectively analyze the clinical manifestations, laboratory indexes, rescue treatment and prognosis of acute fulminant myocarditis in children and discuss the clinical features and effective and safe treatment of fulminant myocarditis in children. Methods: 16 cases of acute fulminant myocarditis complied with the inclusion criteria were collected and analyzed from January 2008 to December 2012 in Sichuan Huaxi No.2 Hospital. The clinical manifestations, electrocardiogram, B-ultrasonography, serum biochemical indexes, rescue and treatment methods were retrospectively analyzed And prognosis, and summarize the diagnostic and rescue treatment characteristics. Results: The 16 cases of fulminant myocarditis were mainly school-age children, with a mean age of 7.19 ± 4.69 years. There were 10 cases (62.5%) with symptoms of gastrointestinal symptoms on admission, 7 cases (43.75%) with respiratory symptoms, Six patients (37.5%) had symptoms of heart failure (palpitations and chest pain), of which 8 patients had fever (50%). In 16 children with fulminant myocarditis on admission, 9 cases showed abnormal X-ray findings (56.25%), including 3 cases of increased cardiac shadow, 5 cases of pulmonary edema / congestion, 6 cases of pleural effusion, 8 cases of echocardiography The mean ejection fraction (EF) was (50 ± 15)%, the mean fractional shortening (FS) was (29 ± 15)%, the left ventricular enlargement was 5 and the left ventricular systolic function was decreased by 4 , Valvular regurgitation in 4 cases, and pericardial effusion in 3 cases. The electrocardiogram showed abnormality in all degrees (100%), of which 8 cases (50%) had Ⅲ degree block and 15 cases (93.75%) had elevated troponin. During rescue treatment, 15 cases were treated with methylprednisolone (93.75%), 11 cases were treated with gamma globulin (68.75%), 8 cases were treated with temporary pacemaker (50%) and 5 cases were ventilator support 31.25%), 4 cases of blood purification treatment (25%). Among them, 6 died in the acute phase (37.5%), the average length of stay was 5.3 days. Ten patients survived and were discharged better. The average length of stay was 26.5 days. The patients were discharged from hospital in January and were followed up for myocardial enzymes, liver and kidney function, echocardiographic recovery Normal, 2 cases of secondary epilepsy sequelae and long-term oral antiepileptic drugs. Among the 16 cases of fulminant myocarditis, 9 cases were complicated with multiple organ dysfunction syndrome (56.25%). Four cases of severe organ failure were ventilated assisted ventilation, temporary pacemaker and continuous blood purification combined treatment, Three survived and one died. Conclusions: The incidence of fulminant myocarditis is acute and the condition is heavy. Most of the early onset of symptoms are mainly extracardiac symptoms. Misdiagnosis and misdiagnosis are the most common causes. The mortality rate in acute phase is high. The electrocardiogram, echocardiography and chest radiography should be performed in the suspected cases judgment. Once diagnosed with early need of anti-heart failure, cardiogenic shock, anti-arrhythmia treatment.