| Objective:To summarize and analyze the clinical characteristics and management of fulminant myocarditis in children,so as to provide the clinical basis for the early diagnosis and treatment of the disease.Methods:To retrospectively analyze the clinical data of 68 children with fulminant myocarditis that were admitted to Children’s Hospital Of Chongqing Medical University from January 2010 to December 2017.According to the survival status of discharge,patients were divided into survival group and death group.Results:1.A total of 68 cases,30(44.1%)of males and 38(55.9%)of females.45(66.2%)of survival,23(33.8%)cases of death.The age of onset ranged from 3months old to 14 years old,and the average age was(6.5±4.4)years.The time from onset to hospitalization ranged 15 minutes from 15 days,the median time of it was 3 days,19(27.9%)within 24 hours,and 47(69.1%)within 3 days.2.The early clinical manifestations of fulminant myocarditis were mainly external heart,The most common type was digestive system with 22(32.4%),then followed by respiratory system with 20(29.4%),nervous system with 16(23.5%),and circulatory system with 10(14.7%).3.Electrocardiogram showed various abnormality.45(66.2%)abnormal ST-T or T wave,31(45.6%)ventricular premature beat,23(33.8%)ventricular tachycardia,and 21(30.9%)third degree atrioventricular block.LVEF(%)in survival group(56.8±14.0)and death group(39.2±8.1)had significant differences(P=0.001);LVFS(%)in survival group(30.1±9.6))and death group(18.0±3.9)also had significant differences(P=0.004).The c TnI/hs-cTnI,CKMB and BNP in the death group were higher than those in the survival group,but there was no statistical difference between the two groups(P > 0.05).4.IVIG: The survival group with 30(44.1%),and the death group with 8(11.8%),there was significant difference between the two groups(P=0.012);Glucocorticoid: The survival group with 44(64.7%),and the death group with 19(28.0%),the two group had statistical difference(P=0.023).6.A total of 29 cases suffered mechanical ventilation,14(48.3%)in the survival group,and the other 15(51.7%)in the death group,there was a significant difference between the two groups(P=0.007);A tatal of 20(29.4%)used temporary pacemakers,2(10%)of them eventually used a permanent pacemaker.There were 3(4.4%)had blood purification.7.The young age,fever and ventricular arrhythmia were more common in the death group than in the survival group,and there was a statistical difference between the two groups(P < 0.05).Conclusion: 1.Children with fulminant myocarditis is urgent onset and abrupt deterioration,the early clinical manifestation is lack ofspecificity,and most of them are out of the cardiac symptoms,and the mortality rate is high if patients were not treated in time.2.The auxiliary examination of electrocardiogram,echocardiography and myocardial markers are of guiding significance for the early diagnosis of fulminant myocarditis.3.Children with third degree atrioventricular block early in the electrocardiogram were more easily identified and diagnosed in time,and none of them died.4.The clinical effect is accurated that IVIG and high dose glucocorticoids used in the early stage of the disease,and the prognosis will be improved.5.Young age of onset,fever,ventricular arrhythmia,low LVEF and LVFS may be the risk factors that affecting the prognosis of children with fulminant myocarditis. |
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