新型冠状病毒肺炎引起暴发性心肌炎和心包炎的救治体会  

Rescue and treatment experience of fulminant myocarditis and pericarditis caused by coronavirus disease 2019

作　　者：王志勇[1] 支永乐[1] 于洪志[2] 李建国[2] 徐磊[1] Wang Zhiyong;Zhi Yongle;Yu Hongzhi;Li Jianguo;Xu Lei(Department of Critical Care Medicine,Tianjin Third Central Hospital,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Arifcial Cell Engineering Technology Research Center,Tianjin Institute of Hepatobiliary Disease,Tianjin 300170,China;Department of Respiratory and Critical Care Medicine,Tianjin Haihe Hospital,Tianjin 300350,China)

机构地区：[1]天津市第三中心医院重症医学科,天津市重症疾病体外生命支持重点实验室,天津市人工细胞工程技术研究中心,天津市肝胆疾病研究所,天津300170 [2]天津市海河医院呼吸与危重症医学科,天津300350

出　　处：《中国中西医结合急救杂志》2020年第5期536-539,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市科技计划项目(18ZXDBSY00100);天津市卫生健康科技项日(2020XKZ03)。

摘　　要：目的 介绍1例新型冠状病毒肺炎(简称新冠肺炎)引起暴发性心肌炎和心包炎的诊治经过.方法 收集笔者作为支援天津市新冠肺炎定点收治医院医疗队成员时参与救治的1例新冠肺炎引起暴发性心肌炎和心包炎患者的临床资料,该患者经积极治疗后痊愈.通过分析该病例的诊治过程,总结救治经验.结果 患者女性,69岁,因"间断发热7d,胸痛1d",于2020年2月3日入院.流行病学特征:1月20日曾到过天津宝坻百货大楼购物(天津市聚集性疫情发生地).入院后未发现阳性体征.2020年2月2日行胸部CT检查,结果显示肺内可见多发片状磨玻璃密度增高影.2月3日咽拭子新型冠状病毒(2019-nCoV)核酸检测呈阳性.2月3日血常规检查显示:白细胞计数(WBC)12.2×10^9/L,中性粒细胞比例79.8%,中性粒细胞计数(NEU)9.74×10^9/L,淋巴细胞比例10.0%,淋巴细胞计数(LYM)1.22×10^9/L;心肌标志物:肌钙蛋白I(TnI)4.98μg/L,肌红蛋白(Myo)1400μg/L,肌酸激酶同工酶(CK-MB)52.2μg/L;N末端脑钠肽前体(NT-proBNP)35200ng/L;心电图检查显示:窦性心动过速,Ⅱ、Ⅲ、aVF,V2-V6导联ST段抬高;心脏超声检查显示:左室壁运动幅度弥漫性降低,各心腔大小正常,心包积液,左室射血分数(LVEF)0.37.入院后给予氧疗、改善心肌能量代谢、抗炎、抗病毒、抗凝、抗血小板等治疗,患者症状缓解,肺部影像学好转,心功能好转.连续2次咽拭子2019-nCoV核酸检测均呈阴性,于2月29日出院.结论 新冠肺炎引起的暴发性心肌炎和心包炎病情凶险,但经积极综合治疗后预后良好.Objective To introduce a female patient with fulminant myocarditis(FM)and pericarditis caused by coronavirus disease 2019(COVID-19)and diagnosis and treatment process.Methods The elinical data of a patient with FM and pericarditis caused by COVID-19 in Tianjin Haihe Hospital when the author was as a medical team member were collected,after active treatment she was successfully cured.Through the analysis of the diagnosis and treatment process in this case,the rescue and therapeutic experience was summarized.Results The 69-year-old female patient was admitted on February 3,2020 due to"itermittent fever for 7 days and chest pain for I day".Epidemiological characteristics:On January 20,she once shopped at Baodi Department Store in Tianjin(aggregative epidemic ocurring area in Tianjin),No positive signs were found after admission.On February 2,2020,multiple patches of ground glass density could be seen in lungs on chest CT.On February 3,the throat swab 2019 novel coronavirus(2019-nCoV)nucleic acid test presented positive.On February 3,blood routine examination showed:white blood cell count(WBC)12.2×10^9/L,neutrophil ratio 79.8%,neutrmphil count(NEU)9.74×10^9/L,lymphocyte ratio 10.0%,lymphocyte count 1.22×10^9/L;Cardiae markers:troponin I(Tnl)4.98μg/L,myoglobin(Myo)1400μg/L,creatine kinase-MB(CK-MB)52.2μg/L;N-terminal pro-brain natriuretic peptide(NT-proBNP)35200 ng/L.Electrocardiogram examination:simus tachyceardia,Ⅱ、Ⅲ and aVF,V2-V6 lead ST segment elevation.Echocardiography:left ventricular wall motion amplitude was dffusely reduced,each of cardiac cavity was normal in size,presence of pericardial ffusion,left ventricular ejection fraction(LVEF)was 0.37.Afer admission,the patient was given oxygen therapy,drugs for improving myocardial energy melabolism,anti-inlammalion,anlivinus,anticoagulanl,anti-platelet and other symptomatic treatments.The patien's symploms were alleviated,pulmonary imaging and cardiac function were improved.Afer two consecutive throat swab 2019-nCoV nucleic acid lests,the resuls were

关 键 词：新型冠状病毒肺炎 暴发性心肌炎 心包炎 

分 类 号：R54[医药卫生—心血管疾病]