Fu Yun-Ching, Chi Ching-Shiang, Jan Sheng-Ling, Wang Teh-Ming, Chen Po-Yen, Chang Yen, Chou Guan, Lin Chieh-Chung, Hwang Betau, Hsu Shih-Lan
Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
Pediatr Pulmonol. 2003 Apr;35(4):263-8. doi: 10.1002/ppul.10258.
Epidemics of enterovirus 71 infections caused the rapid death of many children in Malaysia in 1997 and in Taiwan in 1998. Pulmonary edema occurred in most of the fatal cases and was considered to be neurogenic. The role of the heart was rarely investigated before. Between January 1998-January 2001, 34 consecutive patients who were admitted to the intensive care unit due to enterovirus infection were studied prospectively. Patients were divided into two groups: group I with pulmonary edema, and group II without pulmonary edema. Comparisons were made between the two groups based upon demographic, neurological, and cardiovascular manifestations. Group I consisted of 11 patients (5 boys, 6 girls; mean age, 22.8 months), and group II of 23 patients (12 boys, 11 girls; mean age, 28.8 months). There were no significant differences between the two groups in comparing sex, age, body weight, neurological severity, intracranial pressure, cell count, protein and glucose levels in cerebral spinal fluid, and blood pressure. All group I patients had left ventricular dysfunction, and their ejection fractions were significantly lower than those of patients in group II (37 +/- 11% vs. 75 +/- 6%, P < 0.001). Group I heart rates were higher than those of group II (175 +/- 24 vs. 137 +/- 25, P < 0.001). In group I, 9 patients who received conventional treatment died, and the only two survivors received left ventricular assist devices. In conclusion, the pulmonary edema of fulminant enterovirus 71 infection is associated with left ventricular failure. Left ventricular function is the major determinant of outcome. Early recognition of heart failure and aggressive cardiac intervention are life-saving. Pediatr Pulmonol. 2003; 35:263-268.
1997年在马来西亚以及1998年在台湾，肠道病毒71型感染的流行导致许多儿童迅速死亡。大多数致命病例出现了肺水肿，且被认为是神经源性的。此前很少对心脏的作用进行研究。在1998年1月至2001年1月期间，对34例因肠道病毒感染而入住重症监护病房的连续患者进行了前瞻性研究。患者被分为两组：第一组为出现肺水肿的患者，第二组为未出现肺水肿的患者。基于人口统计学、神经系统和心血管表现对两组进行了比较。第一组由11例患者组成（5名男孩，6名女孩；平均年龄22.8个月），第二组由23例患者组成（12名男孩，11名女孩；平均年龄28.8个月）。两组在性别、年龄、体重、神经严重程度、颅内压、脑脊液细胞计数、蛋白质和葡萄糖水平以及血压方面没有显著差异。所有第一组患者均有左心室功能障碍，其射血分数显著低于第二组患者（37±11%对75±6%，P<0.001）。第一组的心率高于第二组（175±24对137±25，P<0.001）。在第一组中，9例接受传统治疗的患者死亡，仅有的两名幸存者接受了左心室辅助装置治疗。总之，暴发性肠道病毒71型感染的肺水肿与左心室衰竭有关。左心室功能是预后的主要决定因素。早期识别心力衰竭并积极进行心脏干预可挽救生命。《儿科肺脏病学》。2003年；35:263 - 268。
