酷似急性心肌梗死暴发性心肌炎临床研究.docVIP

酷似急性心肌梗死暴发性心肌炎临床研究［摘要］ 目的 分析酷似急性心肌梗死(AMI)的暴发性心肌炎(FM)的临床特点。方法 对8例心电图出现典型AMI样改变的FM患者，从病史特点、临床表现、辅助检查等方面进行分析。结果 8例患者既往均无冠心病、糖尿病等病史。6例在发病前有上呼吸道感染症状，5例心电图的前壁及下壁导联上同时有ST段抬高或异常Q波，8例患者心肌损伤标志物均明显升高。3例心脏超声检查示心脏结构无明显异常，但收缩功能减退；5例左心室腔明显扩大，心脏收缩功能明显减退。8例均未见心脏节段性功能障碍。2例行急诊冠脉造影术，结果均未发现冠状动脉有明显狭窄。6例应用了主动脉内气囊反搏术。抢救成功7例，死亡1例。结论 酷似AMI的FM发病急骤，病情凶险，分析其临床特点对于及早确诊、积极治疗和改善患者的预后具有重要意义。? ［关键词］ 暴发性心肌炎；急性心肌梗死；心电描记术? ［中图分类号］ R542.21［文献标识码］ A［文章编号］ 1671-7562(2008)04-0252-03 Clinical analysis of acute myocardial infarction-like fulminant myocarditis CHEN Long，ZHANG Xiao-li，TANG Cheng-chun，FENG Yi，MA Gen-shan (Department of Cardiology,Zhangda Hospital，Southeast University，Nanjing 210009,China) Abstract: Objective To analyze the clinical manifestations of acute myocardial infarction(AMI)-like fulminant myocarditis(FM). MethodsThe analysis of characteristics of history, clinical course, and findings of laboratory test and myocardial imaging in eight patients with FM was performed whose findings in electrocardiogram(ECG)were compatible with that of AMI. Results Of all 8 patients, 5 were male, 3 were female. Mean age was 35.5years. All 8 patients had no history of coronary heart disease or diabetes mellitus. Six patients had flu-like symptoms before the onset of FM. Pump failure was seen in all patients 24 hours after admission. The ECG abnormalities were seen in both anterior precordial leads and inferior leads in 5 patients. Singnificant increase in cardiac biomarkers was found in all patients(creatine kinase: 720～7 775 U#8226;L-1; creatine kinase′s isoform: 50～340 U#8226;L-1; Troponin I: 6.0～100 ng#8226;ml-1). Systolic dysfunction was found in all patients(5 patients with left ventricular dilatation)；no regional motion abormality in echocardiography was found in all patients. Emergency agiogramphy was performed in 2 patients and no obvious coronary artery stenosis was observed, intra-aotic balloon counterpulsation is applied in 6 patients, and 7 patients survived. Conclusions Acute