病毒性心肌炎患儿心室晚电位检测及其临床意义  

Measurement and its clinical significance of ventricular late potential of children with viral myocar-ditis

作　　者：冯凤仪[1] 周淑娴[2] 

机构地区：[1]江门市中心医院儿科,广东省江门529000 [2]中山大学附属孙逸仙医院

出　　处：《中国医师杂志》2012年第10期1323-1326,共4页Journal of Chinese Physician

摘　　要：目的探讨小儿病毒性心肌炎的心室晚电位（VLP）与其病情程度、心功能之间的关系，为临床判定患儿病情和治疗提供依据。方法将本院152例病毒性心肌炎患儿按病情程度分为轻症组（128例）和重症组（24例）。重症组患儿病情程度分为严重心律失常组（10例），急性心功能衰竭组（心衰组，9例），心源性休克组（休克组，5例）。选择本院同期50名健康体检正常儿童为对照组。各组分别抽血检测cTnI水平，并进行VLP检查，病例组患儿行彩色超声心动图检查，比较各组血清cTnI水平、与VLP及心功能指标的变化。结果轻症组患儿经治疗后痊愈出院，重症组中7例死于急性期，余患儿均抢救成功并治愈（70．8％）。轻症组和对照组VLP均为阴性，重症组VLP阳性率为75．0％（18／24），可疑阳性率12．5％（3／24），3例为阴性（12．5％）。重型VMC组与轻症组相比，LAS明显延长（P〈0．01），RMS。明显降低（P〈0．05）。，重型VMC组与对照组相比，QRST延长（P〈0．05），LAS明显延长（P〈0．01），RMS。明显降低（P〈0．01）。重症组中严重心律失常组VLP阳性率为60．0％（6／10），心衰组VLP阳性率为77．78％（7／9），休克组VLP阳性率为100％（5／5），随病情加重而VLP阳性率升高（P〈0．05）。重症VMC的VLP中LAS、RMS。与LVFS呈等级负相关（r=-0．404，-0．372，P〈0．05）。结论轻症病毒性心肌炎患儿血清肌钙蛋白（cTnI）水平升高，心室晚电位阴性其预后良好；重症患儿血清肌钙蛋白（cTnI）水平升高，心室晚电位阳性其病情凶险，及时救治可改善预后。血清肌钙蛋白（cTnI）水平及心室晚电位（VLP）对病毒性心肌炎的诊断、病情严重程度的甄别及预后有指导作用。Objective Explore the relationship of ventricular late potential （VLP） and the heart function of children with viral myocarditis, and provide the evidence for their diagnosis and therapy. Meth- ods The clinical data of 152 cases of epileptic children were collected. The patient group was divided into three groups （severe arrhythmia, heart failure, and cardiogenic shock）. The patient group was also divided into two groups （cardiac dilatation, and non-cardiac dilatation） according to UCG. Serum levels of eTnI and VLP in children with viral myocarditis were detected. Results The VLP was negative in the mild and con- trol groups, but the positive rate of VLP is 75.0 % in the severe group. The positive rate of VLP was 60. 0% in the severe arrhythmia group, 77. 78% in the heart failure group, and 100% in the shock group. There is one kind of negative rank correlation between LAS, RMS4o and LVFS （ P 〈 0. 05 ） , and another negative rank correlation between RMS4o and LVEF （ P 〈 O. 05 ）. Conclusions The ~hildren with viral myocarditis have a favorable prognosis. The sever patient in the minority must be diagnosed in time and trea- ted because of the critical state of viral myocarditis children. The serum level of cTnI and VLP were in- creased in children with viral myocarditis, and they were sensitive parameters to reflect patients＇condition.

关 键 词：病毒性疾病 病理生理学 电位测定法 急性病 心肌炎 病理生理学 心室 

分 类 号：R72[医药卫生—儿科]