本文選題：急性心肌炎 + 臨床分析��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:總結(jié)分析成人急性心肌炎的臨床資料,歸納其臨床特征,為疾病早期診斷、提高治愈率提供科學(xué)依據(jù)。方法:回顧性分析吉林大學(xué)第一醫(yī)院心血管疾病診治中心2006年1月至2016年12月收治的112例成人急性心肌炎病例的臨床資料,包括性別、發(fā)病年齡、住院天數(shù)、血壓、心率、臨床表現(xiàn)、輔助檢查、診斷、治療及轉(zhuǎn)歸情況等。以急性重癥心肌炎為重癥心肌炎組,其余為非重癥心肌炎組。以酷似心肌梗死的急性心肌炎為酷似心梗心肌炎組,其余為非酷似心梗心肌炎組。總結(jié)成人急性重癥心肌炎和酷似心肌梗死心肌炎的臨床特征。應(yīng)用SPSS23.0統(tǒng)計(jì)軟件分析以上臨床資料并得出結(jié)論。結(jié)果:112例成人急性心肌炎患者中,男性65例(58.0%),女性47例(42.0%),男、女比例1.38:1,平均發(fā)病年齡為33.46±13.52歲。有前驅(qū)感染史者79例(70.5%),以發(fā)熱(41.1%)、咽痛(26.7%)、咳嗽(20.5%)常見。心電圖以不同程度ST-T改變和心律失常多見(85.7%)。心臟彩超以不同部位、程度的室壁節(jié)段性運(yùn)動異常多見(33.0%)。112例患者中,104例(92.9%)治愈或好轉(zhuǎn),2例病危要求出院,6例死亡。重癥心肌炎組30例(26.8%),非重癥心肌炎組82例(73.2%)。重癥心肌炎組心率、AST、LDH、WBC、Ne、NT-pro BNP高于非重癥心肌炎組,LVEF低于非重癥心肌炎組(P0.05)。多因素Logistic回歸分析顯示,LVEF降低是急性心肌炎發(fā)展為急性重癥心肌炎的獨(dú)立危險因素。酷似心梗心肌炎組41例(36.6%),酷似心梗心肌炎組AST,LDH,cTnI較非酷似心梗心肌炎組高(P0.05)。結(jié)論:1、急性心肌炎患者多數(shù)存在呼吸系統(tǒng)感染等前驅(qū)癥狀。2、重癥心肌炎組心率、AST、LDH、WBC、Ne、NT-pro BNP高于非重癥心肌炎組,LVEF低于非重癥心肌炎組。3、LVEF降低是急性心肌炎發(fā)展為急性重癥心肌炎的獨(dú)立危險因素。4、酷似心梗心肌炎組AST,LDH,cTnI較非酷似心梗心肌炎組高,急性心肌炎與急性心肌梗死難以鑒別時,建議盡早行冠脈造影檢查,避免延誤病情。
[Abstract]:Objective: to summarize and analyze the clinical data of adult acute myocarditis, summarize its clinical characteristics, and provide scientific basis for early diagnosis and improvement of cure rate. Methods: the clinical data of 112 adult patients with acute myocarditis admitted from January 2006 to December 2016 in the Cardiovascular Disease Center of the first Hospital of Jilin University were retrospectively analyzed, including sex, age of onset, length of stay, blood pressure and heart rate. Clinical manifestation, auxiliary examination, diagnosis, treatment and prognosis. Acute severe myocarditis was regarded as severe myocarditis group, and the rest was non-severe myocarditis group. Myocardial infarction-like acute myocarditis was seen as myocardial infarction-like myocarditis group, and the rest was non-myocardial infarction-like myocarditis group. To summarize the clinical features of acute severe myocarditis and myocardial infarction-like myocarditis in adults. SPSS 2 3.0 statistical software was used to analyze the above clinical data and draw a conclusion. Results among 112 adult patients with acute myocarditis, 65 (58.0%) were male and 47 (42.0%) female. The ratio of male to female was 1.38: 1. The average age of onset was 33.46 鹵13.52 years old. There were 79 cases (70.5%) with history of preinfection. Fever (41.1%), sore throat (26.7%) and cough (20.5%) were common. ST-T changes and arrhythmias were more common in electrocardiogram (85.7%). Abnormal segmental motion of ventricular wall was more common in different parts and degrees of echocardiography (33.0%). 104 cases (92.9%) were cured or improved. 6 cases died. There were 30 cases (26.8%) in severe myocarditis group and 82 cases (73.2%) in non-severe myocarditis group. In severe myocarditis group, the heart rate of ASTX LDHN WBCU neNT-pro BNP was higher than that of non-severe myocarditis group (P 0.05), and LVEF was lower than that of non-severe myocarditis group (P0.05). Multivariate logistic regression analysis showed that the decrease of LVEF was an independent risk factor for the development of acute myocarditis to acute severe myocarditis. There were 41 cases (36.6%) in myocardial infarction like myocarditis group, and the AST LDH cTnI group was higher than that in non-myocardial infarction like myocarditis group (P 0.05). Conclusion: 1, most of the patients with acute myocarditis have respiratory system infection and other precursor symptoms. In severe myocarditis group, the heart rate is higher than that in non-severe myocarditis group. The decrease of LVEF is lower than that of non-severe myocarditis group. The decrease of LVEF is that the acute myocarditis develops into acute severe myocarditis, and the decrease of LVEF is higher in severe myocarditis group than in non-severe myocarditis group. The independent risk factor of myocarditis. 4. The ASTU LDHnI group was higher than that in the non-myocardial infarction myocarditis group, which was similar to the myocardial infarction myocarditis group, and the risk factor was higher in the myocardial infarction myocarditis group than in the non-myocardial infarction myocarditis group. When it is difficult to distinguish acute myocarditis from acute myocardial infarction, coronary angiography should be performed as soon as possible to avoid delay.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R542.21

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