新冠病毒疫情下病毒性心肌炎的临床分析与诊断流程  

Clinical analysis and diagnosis process of viral myocarditis under the outbreak of coronavirus disease 2019

作　　者：徐生辉 杨醒[1] 李希大 罗永燕[1] 彭广宇 孙博禹 董豪坚[1] XU Sheng-hui;YANG Xing;LI Xi-da;LUO Yong-yan;PENG Guang-yu;SUN Bo-yu;DONG Hao-jian(Guangdong Provincial People's Hospital Zhuhai Hospital,Zhuhai,Guangdong 519090,China)

机构地区：[1]广东省人民医院珠海医院,广东珠海519090

出　　处：《岭南心血管病杂志》2020年第4期447-451,共5页South China Journal of Cardiovascular Diseases

基　　金：国家重点研发计划-急诊再灌注治疗策略优化研究(项目编号:2016YFC1301202)。

摘　　要：目的分析新型冠状病毒(severe acute respiratorysyndrome coronavirus 2,SARS-CoV2)疫情期间,成人病毒性心肌炎的临床诊治特点,探讨疫情期间病毒性心肌炎的诊断流程。方法对SARS-CoV2疫情公共卫生事件一级响应期间(2020年1月17日至3月5日)广东省人民医院珠海医院收治的4例病毒性心肌炎的临床资料及诊疗经过进行回顾性分析。结果4例患者中的3例表现类似急性心肌梗死,通过冠状动脉计算机断层扫描血管造影(computed tomography angiography,CTA)排除急性冠状动脉病变,通过血常规、胸部计算机断层扫描(computed tomography,CT)、SARS-CoV2核酸检测排除SARS-CoV2感染。4例患者均按本院病毒性心肌炎诊疗流程进行防护与隔离,经过系统治疗,均病情好转出院,未发生院内SARS-CoV2感染。结论对于疫情期间临床诊断为病毒性心肌炎的患者,应与冠状病毒病2019(coronavirus disease 2019,COVID-19)进行鉴别,排除SARS-CoV2感染导致心肌炎的可能。各医院可结合本院实际情况制定相应诊疗流程,在快速识别和诊断病毒性心肌炎的同时,谨防院内SARS-CoV2感染。Objectives To analyze the clinical diagnosis and treatment features of adult viral myocarditis,and discusses the diagnostic process of viral myocarditis during the outbreak of severe acute respiratory syndrome coronavirus 2(SARS-CoV2).Methods During the stage 1 public health response to SARS-CoV2 outbreak(2020.01.17-2020.03.05),the clinical data and the process of diagnosis and treatment of 4 patients with adult viral myocarditis from Guangdong Provincial People’s Hospital Zhuhai Hospital were retrospectively analyzed.Results Three of the 4 patients in performance were similar to acute myocardial infarction,excluding acute coronary lesions by coronary computed tomography angiography(CTA),excluding SARS-CoV2 infection by routine blood,chest computed tomography(CT)and SARSCoV2 nucleic acid detection.All the 4 patients were protected and isolated according to the diagnosis and treatment procedures of viral myocarditis in our hospital.After system treatment,4 patients got better discharged from hospital,and nosocomial infection of SARS-CoV2 did not occur.Conclusions Patients clinically diagnosed with viral myocarditis during the outbreak of SARS-CoV2 should be differentiated from coronavirus disease 2019(COVID-19),and the possibility of myocarditis caused by SARS-CoV2 infection should be ruled out.Each hospital can make corresponding diagnosis and treatment procedures based on the actual situation of each hospital,rapidly identifying and diagnosing viral myocarditis and avoiding novel SARS-CoV2 infected in hospital.

关 键 词：病毒性心肌炎 新型冠状病毒 冠状病毒病2019 

分 类 号：R542[医药卫生—心血管疾病]