循环支持联合免疫调节治疗暴发性心肌炎的疗效观察  

Efficacy of circulatory support combined with immunomodulatory therapy for fulminant myocarditis

作　　者：王晓玲 许蓓 张利芸[1] 陈娟[1] 陈曼华[1] WANG Xiao-ling;XU Bei;ZHANG Li-yun;CHEN Juan;CHEN Man-hua(Department of Cardiology,the Central Hospital of Wuhan,Hubei Wuhan 430024,China)

机构地区：[1]武汉市中心医院心血管内科,湖北武汉430024

出　　处：《内科急危重症杂志》2022年第6期469-472,481,共5页Journal of Critical Care In Internal Medicine

摘　　要：目的:分析循环支持联合免疫调节治疗对暴发性心肌炎患者的疗效。方法:回顾性分析心血管内科重症监护室(CCU)及重症医学科(ICU)收治的23例暴发性心肌炎患者临床资料。根据治疗方式将其分为免疫调节组(13例)和循环支持组(10例),2组患者均接受免疫调节治疗,而循环支持组在此基础上联合循环支持进行治疗。收集患者基线资料(性别、年龄等)、肌钙蛋白I(cTnI)峰值水平、N末端B型利钠肽(NT-proBNP)峰值水平、治疗前后的左心室射血分数(LVEF)及主要疗效。结果:23例患者治疗前LVEF(40.15±14.62)%、峰值cTnI 20.63(10.21,37.32)ng/mL、峰值NT-proBNP 5748(1892,9785)pg/mL。23例患者存活率74%,其中2组各死亡3例,平均住院(11.66±10.39)d,17例患者出院LVEF(53.15±12.83)%。与治疗前比较,2组LVEF值明显提高(P<0.05)。与免疫调节组比较,循环支持组心脏骤停发生率更高,接受机械通气及CRRT治疗的更多(P均<0.05)。结论:以循环支持联合免疫调节治疗为核心的救治方案可有效改善患者心脏功能、提高暴发性心肌炎患者存活率。Objective:To analyze the therapeutic effect of the circulatory support combined with immunomodulatory therapy for patients with fulminant myocarditis.Methods:The observational study reviewed 23 patients with fulminant myocarditis admitted to the Intensive Care Unit(CCU)and Intensive Care Unit(ICU).According to the treatment regimens,we divided patients into immunomodulatory therapy group(n=13)and circulatory support group(n=10).All patients in two groups accepted immunomodulatory therapy,and those in circulatory support group accepted additional circulatory support.We collected the basic clinical data[gender,age,the peak value of cardiac troponin I(cTnI),the peak value of N-terminal pro-B-type natriuretic peptide(NT-proBNP),left ventricular injection fraction(LVEF)level]before and after treatment and the main treatment results.Results:Among 23 patients,before therapy(baseline data),the mean LVEF levels were(40.15±14.62)%;the mean peak value of cTnI was 20.63(10.21,37.32)ng/mL;and the mean peak value of NT-proBNP was 5748(1892,9785)pg/mL.Among the 23 patients,the survival rate was 74%after therapy,and there were 3 deaths in each group.The mean hospitalization time was(11.66±10.39)days.Among the 17 survived patients,the mean LVEF was(53.15±12.83)%at discharge,which was significantly improved in two groups as compared with that before therapy(all P<0.05).Conclusion:A comprehensive treatment regimen with immunomodulation therapy in combination with circulatory support therapy could effectively improve the cardiac function and increase the survival rate of patients with fulminant myocarditis.

关 键 词：暴发性心肌炎 循环支持 免疫调节治疗 存活率 

分 类 号：R542.2[医药卫生—心血管疾病]