| Objective:To summarize the clinical characteristics and treatment measures of fulminant myocarditis(FMC)in children,provide clinical evidence in its early diagnosis and treatment,and lay the foundation for the large-scale randomized controlled trials.Methods:The retrospective study analysed the data of 40 cases of FMC in children admitted to our hospital from March 2009 to December 2016.According to the acceptance of Extracorporeal membrane oxygenation(ECMO),27 cases were classified as ECMO group and 13 cases as no ECMO group.In each group,children were classified as death group and survival group according to the prognosis.The general condition,clinical manifestation,result of auxiliary examination,therapeutics and prognosis were analyzed and summarized by the SPSS 17.0 statistical analysis software.Results:1.General informations:There were 40 FMC patients involved,22 males(55%)and 18 females(45%),the age of onset ranged from two months to 13 years(7.50±3.85 years).The shortest time to our hospital after onset was 8 hours,the longest was 10 days,median time was 3 days.2.Clinical manifestations:Digestive system performance(75%)was the most common initial symptom,14 cases(35%)had prodromal symptoms of upper respiratory infection and 20 cases(50%)had a fever;The most common signs were weak heart sound(70%)and hepatomegaly(40%).3.Laboratory data:(1)Etiological examination:25 cases were detected with Coxsackie virus and the results were all negative.(2)White blood cell(WBC)and C-reactive protein(CRP):WBC increased in 42.5%(17/40)of the cases,the level of WBC was 10.70(6.43?18.39)×10?9/L.In the no ECMO group,the level of WBC in death group was higher than that in survival group(P<0.05);CRP increased in 48.7%(19/39)of the cases,the level of CRP was 7(4?17)mg/L;(3)Creatine kinase isoenzyme MB type(CKMB)?High-sensitivity Troponin T(hs-TnT)and N-terminal proB type natriuretic peptide(NT-proBNP):CKMB increased in 88.8%(32/36)of the cases,hs-TnT increased in 94.4%(34/36).In the ECMO group,the level of hs-TnT in death group was higher than that in survival group(P<0.05);All cases had NT-proBNP increased.In the no ECMO group,the level of NT-proBNP in death group was higher than that in survival group(P<0.05).(4)Electrocardiogram(ECG):97.3%(37/38)of the patients were abnormal.ST-T change(57.8%),sinus tachycardia(52.6%),atrioventricular block(34.2%)and ventricular tachycardia(34.2%)were common in ECG performance.(5)Ultrasonic cardiogram(UCG):Left ventricular ejection fraction(LVEF)decrease(71.7%),atrial or ventricular dilatation(28.2%),ventricular septum or left ventricular posterior wall thickness(20.5%)were common in UCG performance.In the no ECMO group,LVEF in death group was lower than that in survival group(P<0.05).4?Treatment:The glucocorticoid and intravenous immunoglobulin(IVIG)were used in 97.5%and 87.5%cases;13 patients accepted ECMO treatment;The mortality in no ECMO group was higher than that in ECMO group(P<0.05).5.Prognosis:15(37.5%)cases were dead,23(57.5%)cases were survived,2(5%)cases were going to rehabilitation therapy after leaving hospital.Conclusions:Manifestations of FMC in children are various,digestive system performance is the most common initial symptom.So it is difficult for early diagnosis.Currently,the positive rate of Coxsackie virus is greatly reduced,and CKMB?hs-TnT?NT-proBNP still plays an important role in diagnosis of the FMC.The increase of WBC and NT-proBNP,and the decrease of LVEF may affect the prognosis of patients with FMC.The traditional treatments of FMC mainly include symptomatic supportive,anti heart failure,anti-shock,antiarrhythmia,glucocorticoid and IVIG.With the help of ECMO,survival rate in patients with FMC is greatly improved.ECMO becomes a first-line treatment in patients with FMC. |
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