| Objectives: The clinical diagnosis and treatment of fulminantmyocarditis (FMC) are summarized, so that these patients can receivediagnosis and treatment as soon as possible according to the result.Methods: The clinical information of70cases of FMC in childrenwho received clinical diagnosis and treatment in Children’s Hospital ofChongqing Medical University during Jun1998and Oct2010wasreviewed in retrospective analysis. The general condition, clinicalmanifestation, result of auxiliary examination, therapeutics and prognosiswere analyzed and summarized. Using the SPSS19.0statistical analysissoftware to analyze the data above.Results:1. Generals: There were70FMC patients involved,36males(51.43%) and34females(48.57%) were analysised, the age of onset rangedfrom7days to14years, average was (4.99±4.21) years. The shortest timeto hospital after onset was15minutes, the longest was15days,46caseswas within3days.2. Clinical manifestations:67cases(95.71%) were suffered from theprodromic infection. Respiratory(28.57%) and digestive(27.14%) system performance were the most common initial symptoms. The most commonmanifestation were decreasing of activity level(85.71%)、cyanosis(67.14%)、 pale complexion(74.28%), signs were weakcardiechema(95.71%)、arrhythmia(45.71%), complications were congestiveheart failure(78.57%)、cardiogenic shock(62.86%)、sustained ventriculartachycardia(32.86%) or Adams-Stokes syndrome(32.86%) and so on.3. Auxiliary examination:(1) Etiological examination: Coxsackie virus type B(CBV) found in35.71%of the patients was the most common pathogen.(2) Cardiac creatase and cardic troponin: Cardiac creatase in94.44%（51/54）and cardic troponin in31.11%(14/45) of the cases wereabnormal, MB isoenzyme of creatine kinase(CK-MB) in74.07%(40/54) ofpatients elevated. CK-MB、 Aspartate aminotransferase(AST)、 Lactatedehydrogenase(LDH) of cure group were lower than that of deathgroup(P<0.05). Before and after treatment, Creatine kinase、CK-MB、AST、LDH、Hydroxybutyrate dehydrogenase (P<0.05) had significantdifference.(3) Electrocardiogram(ECG):93.85%(61/65) of the patients wereabnormal. ST-T change、T wave change and arrhythmia was most commonin ECGs.(4) Ultrasonic cardiogram (UCG):93.10%(27/29) of the cases wereabnormal. Left ventricular fraction shortening(LVFS) of cure group was higher than that of death group(P<0.05). The Left ventricular ejectionfraction and LVFS in post-treatment were higher than that before treatment(P<0.05).4. Therapies: It’s emphasized that therapy should be symptomaticand comprehensive. The utilization rate of glucocorticoid was77.14%. Thecure rate of using glucocorticoid (55.10%) was higher than that of notusing(8.33%)(P<0.05). The usage of intravenous immunoglobulin (IVIG)was22.86%. In the same, the cure rate(68.75%) was also higher than thatof not using(37.78%)(P<0.05).5. Prognosis:28(40.00%) cases were cured,33cases(47.14%) weredead, and we lose the prognosis of9cases for leaving hospital voluntarilyand loss to follow-up.Conclusion:1. Manifestations of FMC in children are various and always presentas prodrome of infection. Respiratory and digestive system performanceare the most common initial symptoms. So it’s difficult for early diagnosis.Most cases are acute in onset. The common complications are heartfailure、cardiogenic shock、severe arrhythmia or Adams-Stokes syndromeetc that lead to a high fatality rate.2. CBV is the most common pathogen in children with viralmyocarditis. CK–MB and cardic troponin rise is one specific characteristic of myocarditis. ECG and UCG results have no specificperformance, but for the diagnosis have important clinical evidence.3. Treating the FMC in children with glucocorticoid and IVIG early,the rescue success rate may increase. |
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