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目的探讨小儿暴发性心肌炎的误诊原因。方法总结15例小儿暴发性心肌炎患者的临床资料。结果 15例中误诊为胃炎或胃肠炎7例,支气管肺炎3例,中枢神经系统感染2例,上呼吸道感染2例,过敏性休克1例。结论暴发性心肌炎临床表现缺乏特异性,多以心外表现为主,忽视对心脏的认真体检,心肌酶早期增高可不明显是误诊的主要原因。对于以呼吸道、消化道、中枢神经系统为主要症状的患儿,伴有精神萎靡、苍白、多汗、末梢循环不良时,应考虑到暴发性心肌炎,反复检查心肌酶谱、动态观察心电图、床边超声心动图,及时修正诊断。
Objective To investigate the causes of misdiagnosis of pediatric fulminant myocarditis. Methods The clinical data of 15 cases of children with fulminant myocarditis were summarized. Results Of the 15 cases, 7 cases were misdiagnosed as gastritis or gastroenteritis, 3 cases of bronchopneumonia, 2 cases of central nervous system infection, 2 cases of upper respiratory tract infection and 1 case of anaphylactic shock. Conclusions The clinical manifestations of fulminant myocarditis are lack of specificity. Most of them are mainly extracardiac. Neglecting the careful examination of the heart, the early increase of myocardial enzymes may not be the main cause of misdiagnosis. For respiratory, gastrointestinal, central nervous system as the main symptoms of children, accompanied by apathetic, pale, sweating, poor peripheral circulation, should consider fulminant myocarditis, repeated examination of myocardial enzymes, dynamic observation of ECG, bed Side echocardiography, timely diagnosis and diagnosis.