肺炎支原体肺炎患儿心血管损害的临床分析

目的:探讨肺炎支原体(MP)肺炎患儿并发的心肌损害的发生率、损害的类型及治疗方法。方法:观察79例2001~2004年在我院确诊为肺炎支原体肺炎患儿。男44例,女35例。年龄4个月~15岁。MP肺炎诊断均符合《实用儿科学》(胡亚美,江载芳主编)(第7版)的临床诊断标准〔1〕,均进行Holter、心肌酶、肌钙蛋白、超声心动图及X-ray检查,合并有下述表现之一为有心血管损害:①CK—MB升高或心肌肌钙蛋白I阳性;②24 h动态心电图(Holter)为窦性心动过速、窦性心动过缓、多源、多发或成对室性期前收缩、房性期前收缩,QRS波群低电压,房室传导阻滞及ST—T、改变;③超声心动图或胸片显示:心脏扩大;④心源性休克、心功能不全或心脑综合征。结果:MP肺炎患儿中合并心血管损害者15例,占19.0%。15例合并心肌损害:肌钙蛋白阳性15例,12例心肌酶升高,其中CK—MB升高8例,CK-MB、HDBH、LDH均升高2例,CK—MB、CK、HDBH、LDH、AST均升高2例;10例心律失常,其中窦性心动过速1例,窦性心动过缓l例,室性期前收缩1例,房性期前收缩1例,QRS波群低电压1例,一度房室传导阻滞2例,二度Ⅱ型房室传导阻滞1例,三度房室传导阻滞1例,ST—T改变1例:5例超声心动图及X-ray检查心脏扩大。给予阿奇霉素(10 mg.kg-1.d-1)、维生素C(200 mg.kg-1.d-1)及博迈(5~10 m l/d)治疗,并口服玉丹荣心丸及复合B族维生素14~21天后,11例治愈,4例好转,随访3个月基本痊愈。结论:部分肺炎支原体肺炎患儿可合并心血管损害,其中婴幼儿山于表达能力差,症状、体征不典型,容易漏诊,应注意入院时的症状及心脏体征,及早诊断并提出防治措施,以免贻误病情。

Clinical analysis of mycoplasmal pneumonia children patients with cardiovascular damage

Objective:To explore incidence,pattern and therapy of mycoplasmal pneumonia patients with myocardial damage.Methods:79 patients diagnosed as mycoplasmal pneumonia in this hospital in 2001~2004,all experienced Holter,CK-MB,troponin,echocardiogram and X ray, to be considered cardiovascular damage accompanied as follows:l)CK-MB elevation or positive troponin;.2)24 hour dynamic electrocardiogram hints sinus tachycardia,sinus bradycardia,multifocal or conjugate premature ventricualr contraction,premature atrial contraction,QRS wave group low tension and alteration in S T-T.3) echocardiogram or X ray disclose enlarged heart.4)cardiac shock,cardiac dysfunction or A-S syndrome.Results:15 mycoplasmal pneumonia patients merged cardiovascular damage.15 patients' treponin were positive,12 patients' cardiac enzyme increased,8 cases had increased CK-MB,2 patients' CK-MB,HDBH,LDH elevated,2 patients' CK-MB,CK,HDBH,LDH,AST increased,l0 patients had cardiac arrhythmia,1 patient had sinus tachycardia,1 patient had sinus bradycardia,1 patient had ventricualr contraction,1 patient had premature atrial contraction,1 patient had QRS wave group low tension,2 patients had first degree atrioventricular block,1 patient two degree II type atrioventricular block,1 patient three degree atrioventricular block,1 patient alteration in ST-T,5 patients were heart dilatation by echocardiogram and X ray check.Conclusion:Because mycoplasmal pneumonia child patients with cardiovascular damage have poor expression competence,system and physical sign is not obvious,they are easily missed diagnosis.The system and physical sign of heart should be paid attention to early diagnose and put up with cure measurein so as to avoid delaying pathogenetic condition.