Comparative Study On Early Clinical Indexes Of Fulminant Myocarditis And Common Myocarditis In Children

Objective:To analyze and summarize the clinical data of 86 children with viral myocarditis in our hospital,to provide clinical experience for the rapid identification and diagnosis of fulminant myocarditis,so as to improve the survival rate.Methods:The clinical data of 86 patients who were hospitalized in Hunan Provincial People’s Hospital and diagnosed with viral myocarditis from January 2011 to December 2020 were retrospectively analyzed.Among them,21 cases were fulminant myocarditis and 65 cases were in the common myocarditis group.The clinical data included general data,clinical symptoms and signs,laboratory examinations,electrocardiogram,cardiac color Doppler ultrasound,treatment process and outcome.The data of the two groups were compared and analyzed by statistical methods.,Use SPSS 25.0 statistical software for statistical analysis.The measurement data conforming to the normal distribution are represented by the mean±standard deviation,the measurement data not conforming to the normal distribution is represented by the median and its interquartile range;the statistical description of the counting data is represented by the frequency and the composition ratio.The mean comparison of measurement data between the two groups was performed by independent sample t test.X~2test or Fisher’s exact test was used to compare count data between groups,and P<0.05 indicated statistical difference.Results:1.General situation:There were 43 males(66.15%)in the common viral myocarditis group and 22 females(33.85%).The male to female ratio was 1.95:1,and the median age of onset was 14 years old.In the fulminant myocarditis group,there were 21 children with fulminant myocarditis,including 9 males and 12 females.The male to female ratio was 1:1.33,and the median age of onset was 12 years old.2.Clinical manifestations:The fulminant myocarditis group has a larger proportion of the history of pre-infection than the common viral myocarditis group,and the difference is statistically significant.The children in the fulminant myocarditis group had symptoms of the digestive system and nervous system,while the symptoms of the normal viral myocarditis group had the cardiovascular system.Early shock symptoms were more obvious in the outbreak group than in the normal group.3.Laboratory examination:early myocardial damage markers and B-type brain natriuretic peptide levels in fulminant myocarditis,incidence of malignant arrhythmia,obvious abnormal ventricular wall motion,decreased left ventricular systolic function,and decreased LVEF were all significantly more significant than those of common viral myocarditis.4.Auxiliary examination:ST-T changes and various atrioventricular block were the most common electrocardiograms in the fulminant myocarditis group,with Ⅲ-degree atrioventricular block(47.62%)dominated.In the common viral myocarditis group,ST-T changes and premature beats were the most common.The comparison of the two groups in Ⅲ-degree atrioventricular block was statistically significant.Fulminant myocarditis,abnormal ventricular wall motion,decreased left ventricular systolic function,and decreased LVEF were significantly more significant than those of common myocarditis,and the difference was statistically significant.Conclusion:Children’s fulminant myocarditis has a rapid onset,high fatality rate,and various early clinical manifestations.The changes of myocardial injury markers,electrocardiogram and cardiac color Doppler ultrasound are the focus of early auxiliary diagnosis.