| ObjectiveThis study retrospectively analyzed the clinical data and prognosis of fulminant myocarditis.At the same time,the clinical data of common viral myocarditis and fulminant myocarditis were compared and analyzed to provide the basis for the early diagnosis and treatment of the disease and the identification of critical disease.MethodsA total of 39 children with fulminant myocarditis admitted to the pediatric intenseve care unit and department of cardiology in XI’an Children’s Hospital from Januar 1,2015 to October 31,2020 were enrolled as the case group.And 39 chilren with common viral myocarditis who were admitted to the hospital at the same time and in the same age group as the control group.The general clinical data,auxiliary examination results and treatment conditions of the two groups were retrospectively analyzed.According to the outcome,the experimental group was divided into survival group(n=24)and death group(n=15)for intra-group comparative analysis.The survival group was followed up to observe the changes of cardiac enzymes and color Doppler ultrasound.SPSS25.0 was used for statistical analysis.P<0.05 was considered statistically significant.Logistic multivariate regression analysis was performed for the factors with P<0.05.Results1.The first symptoms of the case group and the control group were mainly extracardiac.Comparing the case group with the control group,the signs of admission were disordered consciousness in 12 cases(30.77%)vs 0 cases,pulmonary rales in 14 cases(35.90%)vs 6cases(15.38%),and hypotension in 20 cases(51.28%)vs 0 cases.Cases,24 cases(61.54%)with enlarged liver vs 5 cases(12.82%)with clinical manifestations of heart failure and cardiogenic shock,often complicated by multiple organ dysfunction.2.The aspartate aminotransferase,lactate dehydrogenase,and creatine kinase-MB in the myocardial zymogram of the case group showed bimodal changes;the electrocardiogram indicated that the arrhythmia was dominated by conduction block,and the dynamic electrocardiogram indicated that the arrhythmia was pre-contracted Mainly.Comparing the case group with the control group,the myocardial enzyme spectrum indicators were significantly increased;urea(7.00±5.01mmol/L vs 4.02±1.91mmol/L),creatinine(59.26±39.11μmol/L vs 33.06±10.25μmol/L)Increased;QRS duration(108.00±50.82 ms vs78.91±13.66ms),QT interval(382.95±83.02 ms vs 350.42±44.34ms)prolonged;left ventricular ejection fraction(40.58±12.73% vs 59.88±8.65)%)and left ventricular shortening fraction(20.55±7.39% vs 31.76±5.34%)decreased,both P<0.05,the difference was statistically significant.3.In the case group,comparing with the death group and the survival group,14 cases appearing cardiogenic shock(93.33%)vs 10 cases(41.67%),creatine kinase(2387.00(1053.75,10034.50)U/L vs 727.00(274.00,1522.50)U/L),creatine kinase-MB(266.00(162.25,328.25)U/L vs 67.00(40.50,189.50)U/L),NT-pro brain natriuretic peptide(63602.00(25388.25,108369.25)pg/ml vs 20816.00(3264.50,7977.00)pg/ml)were significantly increased;QRS wave duration(216.79±22.19 ms vs 109.28±58.09ms)was prolonged;left ventricular ejection fraction(34.53±11.04% vs 44.35±12.45%),left The fraction of ventricular shortening(16.56±5.22% vs 22.35±7.63%)decreased,all P<0.05,the difference was statistically significant.4.Logistic regression analysis showed that prolonged QRS duration(OR=4.104,95%CI=0.150-4.709,P=0.018)was a risk factor for poor prognosis of fulminant myocarditis.Decrease of left ventricular ejection fraction(OR=2.467,95%CI=0.532-11.455,P=0.024)and prolonged QRS duration(OR=3.691,95%CI=0.270-50.400,P=0.022)were risk factors for fulminant myocarditis.5.The 24 children in the survival group were followed up for 7 days to 57 months,with an average follow-up time of 29.1±16.3 months.Two cases were lost to follow-up,and 20 cases were cured with a good overall prognosis.One child was followed up for 2 years,the re-examination of heart color ultrasound indicated enlargement of the heart,and dilated cardiomyopathy was diagnosed.Conclusion1.Fulminant myocarditis has more prodrome infection,the first symptom is atypical,the performance is diverse,often to the heart outside the main performance.The presence of disturbance of consciousness,syncope,hypotension,and malignant arrhythmia often indicate a more serious condition.2.Fulminant myocarditis can be complicated with functional impairment of multiple organs such as liver and kidney,and the disease progresses rapidly.Cardiogenic shock,Ass syndrome,malignant arrhythmia and other hemodynamic unstable manifestations can appear in a short period of time.Children with cardiogenic shock have poor prognosis,and malignant arrhythmia is the main cause of death.3.Decrease of left ventricular ejection fraction and prolonged QRS duration are the risk factors for fulminant myocarditis.Prolongation of QRS duration is a risk factor for poor prognosis in fulminant myocarditis.4.Fulminant myocarditis is serious,the course of the disease is fast,the mortality is high,but after passing the acute stage,the prognosis is generally good.There is a risk of developing dilated cardiomyopathy during convalescence. |
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