The Intervention Study Of Continuous Blood Purification For Cardiac Myosin Of Children With Fulminant Myocarditis

Objective:This study investigate the value of continuous blood purification in childrenwith fulminant myocarditis. Monitoring serum cardiac myosin light chain1fluctuations during CBP treatment, to provide the basis for the further research.Methods:We analyzed the children with FM who stayed in the PICU of FirstHospital of Jilin University between November2011to December2014. A totalof40cases of children are qualified. Using drugs for treatment of16cases ascontrol group,24cases used CBP combined with drug treatment as experimentalgroup. The experimental group collected blood for detection of serum CMLC-1.Each child was collected the following parameters:①Gender,Age,weight;②Comparing their length of stay and outcome of the situation;③Compare twogroups of survival before and after treatment of vital signs, electrocardiogram,chest X-ray, echocardiogram, myocardial enzymes, troponin, NTproBNP, whiteblood cells, and lactic acid changes；④Before and after the CBPtreatment,testing the survival in the experimental group with serum CMLC1OD value；⑤Study the CMLC1OD value changes with the same period ofcardiac function, myocardial enzymes, troponin laboratory results of correlation.Results:①There are24male cases,16female cases, the sex ratio is1.5:1. The agedistribution is from2months to14years old, Weight3.8kg to40kg. Thegeneral information of children is comparable, but no statistically significantdifference (P>0.05);②There were9cases abated,7cases died in control group,the mortality rate is43.8%.In the experimental group20cases abated,4cases died, the mortality rate is16.7%.Compared with control group,theexperimental group had significantly lower mortality.Control group survivorswith the average length of hospital stay was20.38±4.59days,while theexperimental group survivors’ was16.55±2.14days. The experimental group ofsurvivors in hospital time significantly shorter than the control group (P<0.01);③Monitoring two groups of survival children after active treatment with heartrate, blood pressure, breathing and other symptoms, they were improved tovarying degrees. Abnormal ECG changes gradually improving, X-ray showscardiothoracic ratio gradually narrowed to the normal range, EF value andexpansion Chambers were restored. Myocardial enzyme spectrum, troponin,NTproBNP, ect also gradually improved during the period of treatment: thecontrol group survivors laboratory examination improved after72hours, but theexperimental group survivors only need48hours, Statistically significantdifferences (P<0.05), and the most significant are myoglobin,CKMB,NTproBNP and lactic acid (P<0.01).④Serum CMLC1concentrationsignificantly increased in the children with FM. No significant difference in thedefree of increase in death and surcical (P>0.05). During the CBP therapy, thesurcical’s serum concentration decreased,obviously within48h (P<0.05).⑤The level over the same period with myocardial enzyme spectrum andmyocardial injury markers, such as laboratory results were positively correlated.Conclusions:①Early positive application of CBP therapy can effectively reduce themortality.②CBP therapy can effectively reduce themyoglobin,troponin,BNP,and lactic acid.③CMLC-1OD value increasedsignificantly in the FM children, CBP can effectively remove it.