�ļ�������С����ȫ�Է��Ҵ�������17���ٴ�����

目的分析感染性心肌炎所致小儿完全性房室传导阻滞(CAVB)的临床特点及治疗,以提高对该病的认识。方法对1984-08—2005-03上海市交通大学附属儿童医院收治的感染性心肌炎所致CAVB17例进行回顾性分析。结果17例CAVB患儿出现阿斯综合征者8例,心功能不全者5例。17例胸片检查心影增大13例。13例心脏超声检查示均有左心室增大。心电图示平均心室率为(52·8±10·4)/min。急重症心肌炎6例,均予甲基泼尼松龙静脉冲击和营养心肌治疗,3例安置临时起搏器进行治疗;其余患儿都以改善传导、增快心室率药物治疗。治愈6例,好转5例,仍为CAVB5例,死亡1例。结论急重症心肌炎发生CAVB可以是致命的,如果能早期诊断、及时应用大剂量肾上腺皮质激素及给予急诊临时起搏器处理,将会取得较好的预后。在随访心肌炎所致房室传导阻滞患儿时,如并有束支传导阻滞者、QRS波增宽、结性逸搏时要高度警惕其可能进展为CAVB。

Complete atrioventricular block resulted from myocarditis in 17 children

?? AbstractObjectiveAnalyzing the clinical characteristics and the treatment in 17 children with complete atrioventricular block (CAVB) resulted from the infectious myocarditis. MethodsFrom Aug.1984 to Mar.2005,17 cases of CAVB resulted from the infectious myocarditis were reviewed. ResultsOf the 17 children reviewed,8 had Adams??Stoke syndrome and 5 had heart failure;13 of them had cardiomegaly on chest x??ray.The echocardiography in 13 cases all showed left ventricular enlargement.The average ventricular rate on electrocardiogram was (52??8??10??4)/min.Six patients with the fulminant myocarditis were given the methylprednisolone and medication for protecting the damaged myocardium.Three patients were given emergence temporary pacing.The rest children were given the medicine for improving conduction.In this group,6 patients were cured,and 5 patients showed clinical improvement,but 5 patients still showed CAVB and 1 patient died. ConclusionCAVB associated with acute myocarditis may be life??threatening;if the patients are diagnosed early enough and are given large doses of the adrenal cortical hormone in time and administered emergence temporary pacing,the prognosis will be much better.On the other hand,if atrioventricular block occurs on follow??up,bundle branch block appears and QRS widens with the nodal escape,the diease may progress to CAVB.