婴儿不同病因所致心力衰竭的临床分析

目的 探讨不同病因所致婴儿心力衰竭的临床特征和诊断.方法 对2003年8月～2007年9月住院的18例心肌疾病心衰,41例先天性心脏病(CHD)合并肺炎心衰及30例肺炎合并心衰患儿临床特征、血清CK、CK-MB变化进行对比分析,对照组为30例肺炎患儿.结果 心肌疾病心衰组有33%存在窦性心动过缓,明显高于CHD肺炎心衰组、肺炎心衰组(P<0.05),CHD肺炎心衰组X线心脏增大、心音低钝发生率明显高于肺炎心衰组(P<0.01),肺水肿、周围灌注不良表现在心肌疾病心衰组、CHD肺炎心衰组,均比肺炎心衰组多见(P<0.05),而肝脏肿大回缩均比较肺炎心衰组慢(P<0.05).3组心衰患儿CK-MB升高,CK-MB/CK异常发生率均高于肺炎对照组(P<0.05),而且,心肌疾病心衰组、CHD肺炎心衰组均高于肺炎心衰组(P<0.05).结论 不同病因所致的心衰临床表现有明显差异,临床上应引起重视.心动过速是心衰的主要依据,但在小婴儿不能单纯以心率不增快而否定心衰,在小婴儿周围灌注不良也是心衰的常见表现.

Clinical analysis of heart failure caused by different etiology in neonates and infants

Objective To investigate the clinical manifestations and diagnose of heart failure(HF) caused by different etiology in neonates and infants. Methods The clinical features and serum level of CK and CK-MB of 18 cases with FIF caused by cardiomyopathies, 41 HF complicated by congenital heart disease (CHD) and pneumonia and, 30 HF complicated by pneumonia and 30 pneumonia under 1 yeas old, hospitalized during 2003.8～2007.9, were analyzed with contrast method. Results The incidence of sinus bradycardia (33%) was significantly higher in HF with cardiomyopathies group than that in HF with CFID and pneumo-nia and HF complicated by pneumonia group (P<0.05), The incidence of cardiac enlargement gained from chest X-ray and cardiechema low waa markedly higher in HF with CHD and pneumonia group than that in HFcomplicated by pneumonia group(P<0.01), The pneumonedema and delayed capillary refill in HF with car-diomyopathies group and CHD and pneumonia group were more common than in HF complicated by pneumo-nia group, and the recovery of hepatomegaly was slower(P<0.05), The CK-MB serum level and CK-MB/CK rate increase in all three HF group were higher than those in pneumonia group, and those in HF with car-diomyopathies and with CHD and pneumonia group were higher than in HF complicated by pneumonia group (P<0.05). Conclusion There is markedly difference in the clinical manifestations and CK-MB serum level and CK-MB/CK rate in patients with HF caused by different etiology. It is unbefitting that HF has not been diagnosed on the basis of the existence of the heart rate non-inerease in neonates and infants. The delayed cap-illary refill is common phenomenon of HF in neonates and infants. So the examiner should pay particular atten-tion to these features when HF is diagnosed.