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目的探讨小儿暴发性心肌炎的临床特点及诊治策略。方法对2008年1月至2013年8月在首都医科大学附属北京儿童医院住院治疗的64例暴发性心肌炎病例进行回顾性分析。其中男39例,女25例;年龄5个月至13岁,平均(6.9±2.2)岁,对患儿的临床表现、诊断、治疗进行分析。结果经治疗58例(90.6%)治愈或好转,6例(9.4%)死亡。60例患儿存在显著心电图异常,阳性率为93.8%。肌酸激酶同工酶(CK-MB)升高40例,心肌肌钙蛋白I(cTnI)升高36例,二者均升高28例。结论暴发性心肌炎临床表现缺乏特异性,及时诊断和救治可以降低病死率,其心电图的改变要早于心肌酶的升高。
Objective To investigate the clinical features and diagnosis and treatment of fulminant myocarditis in children. Methods A retrospective analysis of 64 cases of fulminant myocarditis hospitalized in Beijing Children’s Hospital Affiliated to Capital Medical University from January 2008 to August 2013 was conducted. There were 39 males and 25 females, aged from 5 months to 13 years (mean 6.9 ± 2.2 years). The clinical manifestations, diagnosis and treatment of children were analyzed. Results of the treatment of 58 cases (90.6%) were cured or improved, 6 cases (9.4%) died. 60 cases of children with significant ECG abnormalities, the positive rate was 93.8%. There were 40 cases of elevated creatine kinase (CK-MB), 36 cases of cardiac troponin I (cTnI), both of which increased in 28 cases. Conclusions The clinical manifestations of fulminant myocarditis are not specific. The diagnosis and treatment of fulminant myocarditis can reduce the mortality rate. The change of electrocardiogram should be earlier than the increase of myocardial enzymes.