| Part1:Clinical analysis of single center children’s myocarditis in 2014-2018Objective:To study the early clinical symptoms of myocarditis in children,which providing clinical experience for the diagnosis of myocarditis,especially fulminant myocarditis in order to reduce misdiagnosis of myocarditis and mortality rate.Methods:To summarize and analyse a total of 145 children with myocarditis in our hospital from January 2014 to December 2018,and the children were divided into FM Group and Non-FM Group for analysis.Results:(1)Myocarditis in children was more common in winter and spring.A total of 145 cases,79 cases for males,66 cases of females.47 cases(32.4%)were in FM group,which included 19 of males and 28 of females,while 98 cases(67.6%)were in non-FM group with 60 of males and 38 of females.The female(58.6%)in the FM group was significantly higher than that in the non-FM group(38.8%)(P<0.05).(2)The early clinical manifestations of FM group occurred in digestive system 31(66.0%),nervous system 11(23.4%),dyspnoea 45(95.7%),poor appetite 36(76.6%),and fatigue 31(66%)significantly higher than the non-FM group(P<0.01).(3)The cTnI3,CK-MB mass,Myo and BNP in the FM group were significantly higher than those in the non-FM group(P<0.01).In ECG,ventricular tachycardia(19.1%),ventricular flutter(4.3%),ventricular fibrillation(4.3%),III°AVB(10.6%)in FM group were significantly higher than in the non-FM group(P<0.05)at the beginning of this diease,while ventricular premature beats in FM group(10.6%)is significantly lower than that of the non-FM group(P<0.01).The positive rates of left ventricular ejection fraction(73.3%),cardiac enlargement(75.6%),ventricular septal thickening(37.8%),pericardial effusion(22.2%)and ventricular wall movement abnormality(48.9%)were significantly higher in the FM group than in the non-FM group(P<0.01).(4)In 145 cass,the survival rate was 97.2%,114 cases(78.6%)were cured,4 cases(2.8%)were dead.Conclusion:Myocarditis in children is more common in the winter and spring,which can be seen in all ages.It is worthing that patients with digestive symptoms,neurological symptoms and fatigue should be wary of FM.Myocardial markers,ECG and UCG are usually abnormal at the beginning of the disease,so they should be the first-line auxiliary examination.Myocarditis,especially fulminant myocarditis,often has a high mortality rate,so those who are suspected or confirmed myocarditis should be admitted to hospital for observation and treatment.Part2:Clinical analysis of fulminant myocarditis in single center for 15 yearsObjective:To explore the epidemiology,clinical characteristics and prognosis of fulminant myocarditis in children,providing clinical experience for early diagnosis and treatment of the disease.Methods:To summarize and analyze the clinical data of children with fulminant myocarditis in our hospital from January 2004 to December 2018,including sex,age,clinical symptoms,auxiliary examination,treatment and prognosis.And the clinical characteristics and treatment differences between the survival group and the dead group were compared.Results:(1)There were 70 cases of FM children,29 cases of males(41.4%),41 cases of females(58.6%).The number of children with FM showed an upward trend from January 2004 to December 2018.It was more common in the winter and spring.(2)Most of patients(70.0%))had precursor infection with 3 weeks,mainly in respiratory(58.6%)and enteron(11.4%).(3)The early manifestations of FM were mainly external heart.The most common type was respiratory system with 41(58.6%),the followed by digestive system with 37(52.9%),while infants mainly with poor appetite and fatigue as the symptoms.(4)Comparing of the cardiac biomarkers,it was clear that the positive rates of CK-MB(86.9%),CK-MB mass(80.4%),cTnI3(89.6%)were higher than the positive rates of Myo(45.0%)and the BNP(60.0%)(P<0.05).About 98.6%of electrocardiogram were abnormal,the most common changes were in T-wave(40.0%),sinus tachycardia(35.7%),ST-T(35.7%).Echocardiography showed various abnormalities(89.7%).(5)A total of 70 cases,59 of Survival Group,11 of Death Group.The proportion of dyspnea(72.7%),respiratory and cardiac arrest(27.3%)and ventricular fibrillation(18.2%)in the Death Group was significantly higher than that in the Survival Group(P<0.01).(6)The group which use creatine phosphate was significantly higher than the non-use of creatine phosphate group in survival rate(P<0.01).Also,the survival rate of combined use of two or more nutritional myocardial drugs and the non-co-user had significant difference(P<0.01).The recovery rate of 86.4%using IVIG group was significantly higher than that of unused IVIg Group Survival 13.8%(P<0.05).(7)The survival rate of 70 cases of FM Children(84.2%),of which 43 cases(61.4%)were cured,and 2 cases were fitted with permanent pacemakers.Conclusion:FM in children is more common in the winter and spring,which can be seen in all ages.Children with fulminant myocarditis are in urgent condition and the deterioration of the disease is progressing rapidly.Early clinical symptoms of myocarditis are lack of specificity,mainly digestive symptoms and respiratory symptoms.Those who with respiratory cardiac arrest or ventricular fibrillation may have a risk factor affecting the prognosis.In treatment,it is helpful to improve the survival rate for the use of IVIG and myocardial nutrition drug in children with fulminant myocarditis. |
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