小儿急性心肌炎预后不良因素研究

摘要

目的 评估小儿急性心肌炎不良预后的预测因素.方法 选取182例在我院重症监护病房(ICU)治疗的急性心肌炎患儿,根据患儿的预后情况,将患儿分为完全恢复组(A组,n=109)、未完全恢复组(B组,n=37)与死亡组(C组,n=36).收集并比较各组患儿的临床资料、实验室数据、超声心动图与心电图,询问患儿的用药史与患儿的护理方案,评估患儿病死率与未完全恢复的预测因子.结果 左心室舒张末期内径Z评分(OR=1.252,95% CI 1.005~1.560,P=0.047)、体外膜肺氧合(OR=9.843,95% CI 1.045~92.765,P=0.047)、肾上腺素应用(OR=18.553,95% CI 1.758~195.706,P=0.016)是死亡率的重要预测因子.左心室舒张末期内径Z值(OR=1.361,95% CI 1.067~1.735,P=0.014)是未完全恢复的重要预测因子.结论 诊断时的左心室扩张反映了急性期内严重的心肌损伤,如果诊断时急性心肌炎患儿表现出左心室扩张,临床医生应密切监控以避免患儿病情加重,并积极采用适当治疗措施避免发生较差预后.%Objective To evaluate the prognostic factors of poor prognosis in children with acute myocarditis.Methods 182 children with acute myocarditis in our intensive care unit (ICU) were divided into three groups according to their prognosis: the full recovery group(group A, n=109), the no full recovery group(group B, n=37), the death group (group C, n=36).The clinical data, laboratory data, echocardiographic data and electrocardiogram data were collected and compared.The medication history and nursing plan were collected and the predictors of mortality or incomplete recovery were evaluated.Results The left ventricular end-diastolic diameter z score (OR=1.252, 95%CI 1.005~1.560, P=0.047), extracorporeal membrane oxygenation (OR=9.843, 95%CI 1.045~92.765, P=0.047) Adrenaline use (OR=18.553, 95%CI 1.758~195.706, P=0.016) were important predictors of mortality.Left ventricular end-diastolic diameter z score (OR=1.361, 95% CI 1.067~1.735, P=0.014) was an important predictor of incomplete recovery.Conclusion Left ventricular dilatation at diagnosis reflects severe myocardial injury in the acute phase.If the diagnosis of acute myocarditis results in left ventricular dilatation, the children should be closely monitored to avoid exacerbations and appropriate treatment to avoid poor prognosis.