酷似急性心肌梗死暴发性心肌炎临床研究

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1、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

2、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)04-0252-03Clinicalanalysisofacutemyocardialinfarction-likefulminantmyocarditisCHENLon

3、g，ZHANGXiao-li，TANGCheng-chun，FENG9Yi，MAGen-shan(DepartmentofCardiology,ZhangdaHospital，SoutheastUniversity，Nanjing210009,China)Abstract:ObjectiveToanalyzetheclinicalmanifestationsofacutemyocardialinfarction(AMI)-likefulminantmyocarditis(FM).MethodsTheana

4、lysisofcharacteristicsofhistory,clinicalcourse,andfindingsoflaboratorytestandmyocardialimagingineightpatientswithFMwasperformedwhosefindingsinelectrocardiogram(ECG)werecompatiblewiththatofAMI.ResultsOfall8patients,5weremale,3werefemale.Meanagewas35.5years

5、.All8patientshadnohistoryofcoronaryheartdiseaseordiabetesmellitus.Sixpatientshadflu-likesymptomsbeforetheonsetofFM.Pumpfailurewasseeninallpatients24hoursafteradmission.TheECGabnormalitieswereseeninbothanteriorprecordialleadsandinferiorleadsin5patients.Sin

6、gnificantincreaseincardiacbiomarkerswasfoundinallpatients(creatinekinase:720～7775U•L-1;creatinekinase′sisoform:50～3409U•L-1;TroponinI:6.0～100ng•ml-1).Systolicdysfunctionwasfoundinallpatients(5patientswithleftventriculardilatation)；noregi

7、onalmotionabormalityinechocardiographywasfoundinallpatients.Emergencyagiogramphywasperformedin2patientsandnoobviouscoronaryarterystenosiswasobserved,intra-aoticballooncounterpulsationisappliedin6patients,and7patientssurvived.ConclusionsAcutemyocardialinfa

8、rction-likefulminantmyocarditisisakindoffataldisease.Theanalysisofclinicalmanifestationsplayedanimportantroleinthediagnosis，treatmentandprognosisofFM.�Keywords:fulminantmyocarditis；acutemyocardialinfarction；electroc