体外膜氧合成功治愈暴发性心肌炎一例并文献复习

A Case of Explosive Myocarditis Successfully Cured by Extracorporeal Membrane Oxygenation and Literature Review

摘要: 背景：心肌炎是一种以多态性体征和症状为特征的心肌疾病，暴发性心肌炎以起病急、发展迅速为特点，短期内可出现左心室收缩功能障碍、心源性休克、恶性心律失常，通常需要机械循环支持治疗。我们报告了一例经体外膜氧合(V-A-ECMO)成功治愈的暴发性心肌炎。个案报道：一名19岁的女性，既往体健，因“胸闷5天，加重2天”，就诊于我院。患者入院前曾出现III度房室传导阻滞伴有心源性休克，给予临时起搏器维持心率、大剂量血管活性药物维持血压。入院后高敏肌钙蛋白、肌红蛋白、肌酸激酶、B-型脑钠尿肽升高；心电图提示宽QRS波群心动过速、室性心动过速；经胸超声心动图提示左心室射血分数16%，给予气管插管辅助呼吸、更昔洛韦抗病毒、糖皮质激素及免疫球蛋白抑制炎症反应，评估病情后给予体外膜氧合(V-A-ECMO)治疗。患者病情平稳后行心肌内膜活检(EMB)提示存在暴发性心肌炎，经对症处理后，患者心功能改善后出院。结论：对合并血流动力学不稳定的暴发性心肌炎患者早期应用体外膜氧合可提升生存机率。

Abstract: Background: Myocarditis is a myocardial disease characterized by polymorphic signs and symp-toms. Explosive myocarditis is characterized by rapid onset and rapid progression. Left ventricular systolic dysfunction, cardiogenic shock, and malignant arrhythmia may occur in a short period of time, and mechanical circulatory support is usually required. We report a case of explosive myocar-ditis successfully cured by extracorporeal membrane oxygenation (V-A-ECMO). Case Report: A 19-year-old female, previously healthy, was admitted to our hospital due to “chest tightness for 5 days, aggravated for 2 days”. The patient had grade III atrioventricular block with cardiogenic shock before admission, and was given temporary pacemaker to maintain heart rate and high dose vasoactive drugs to maintain blood pressure. After admission, hypersensitive troponin, myoglobin, creatine kinase, and B-type brain natriuretic peptide increased. Electrocardiogram indicated wide QRS group tachycardia and ventricular tachycardia. The left ventricular ejection fraction was found to be 16% by chest echocardiography. Endotracheal intubation-assisted breathing, gaciclovir anti-viral, glucocorticoid and immunoglobulin were given to suppress the inflammatory response. After assessing the condition, extracorporeal membrane oxygenation (V-A-ECMO) was given. After the pa-tient’s condition stabilized, endomyocardial biopsy (EMB) indicated the presence of explosive myo-carditis. After symptomatic treatment, the patient’s heart function improved and he was dis-charged. Conclusion: Early application of extracorporeal membrane oxygenation can improve the survival rate of patients with explosive myocarditis complicated with hemodynamic instability.