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作 者:陈欧阳[1] 余洁[1] 谭忠友[1] 姜建渝[2] CHEN Ou-yang;YU Jie;TAN Zhong-you;JIANG Jian-yu(Department of Pediatric Internal Medicine;PICU,Chongqing Three Gorges Central Hospital,Chongqing 404000,China)
机构地区:[1]重庆三峡中心医院儿内科 [2]重庆三峡中心医院儿童重症监护室,重庆万州404000
出 处:《川北医学院学报》2019年第4期472-474,478,共4页Journal of North Sichuan Medical College
摘 要:目的:探讨儿童暴发性心肌炎的临床特点及诊治策略。方法:回顾性分析20例暴发性心肌炎患儿临床资料。结果: 20 例患儿中,男性11例,女性9例,年龄1月~14岁,平均年龄7.6岁。患儿多以心外症状为首发表现,早期延误诊断9例(45%)。16例患儿予大剂量甲泼尼龙冲击治疗,13例同时予大剂量丙种球蛋白(IVIG)治疗,9例因呼吸衰竭予机械通气,3例因合并Ⅲ度房室传导阻滞伴反复阿斯发作于入院2 h内予以临时起搏器植入,其中1例并多脏器功能衰竭予临时起博联合连续性血液净化治疗6次(连续肾脏替代+血浆置换)得以存活。20例患儿中存活12例,死亡5例,放弃治疗3例。结论:儿童暴发性心肌炎早期临床表现及辅查结果缺乏特异性,易误诊。早期应用大剂量IVIG和糖皮质激素,必要时予以机械通气、临时心脏起搏支持以及血液净化等综合措施有助于提高抢救成功率。Objective: To explore the clinical characteristics and diagnosis and treatment strategy of fulminant myocarditis (FMC) in children. Methods: The clinical data of 20 children with FMC hospitalized in the Chongqing three Gorges Central Hospital from March 2013 to March 2018 were retrospectively analyzed. Results: 20 cases included 11 male and 9 female cases,aged from 1 month to 14 years old (average age was 7.6 years old).The early symptom of FMC was usually extracardiac symptoms and 9 cases (45%) were diagnosed with early delayed diagnosis.16 cases were treated with high dose methylprednisolone pulse therapy and 13 cases were treated with high dose gamma globulin (IVIG) at the same time.9 cases were treated with mechanical ventilation because of respiratory failure.3 cases were given temporary pacemaker implantation within 2 hours after admission to hospital because of three degree atrioventricular block accompanied by recurrent Ash syndrome.1 patient with multiple organ failure was treated with continuous blood purification for 6 times (continuous renal replacement and plasma exchange).Of the 20 cases,12 cases survived,5 died and 3 gave up treatment. Conclusion: The early clinical manifestations and auxiliary results of FMC lack specificity and are easy to be misdiagnosed.Early use of high-dose IVIG and glucocorticoids,mechanical ventilation,temporary cardiac pacing and blood purification may be helpful to improve the rescue rate.
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