Shi Yu-Jun, Wang Li-Feng, Ma Jun, Chen Yi, Wang Wei-Jun, Xie Cui-Ying
Department of Emergency, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
J Inflamm Res. 2022 Jul 4;15:3761-3768. doi: 10.2147/JIR.S365399. eCollection 2022.
The clinical manifestations and treatment of three patients with hemodynamically unstable lupus myocarditis (LM) were analyzed.
The clinical data of three patients with LM with hemodynamic instability, who were admitted to the emergency ICU of the south hospital of the Renji Hospital, School of Medicine, Shanghai Jiao Tong University of Medicine from January 2018 to December 2021, were collected and analyzed, and relevant literatures were reviewed.
Two of the three patients had the first onset of systemic lupus erythematosus. The other patient had mixed connective tissue disease in the past, and lupus was the main manifestation of this disease. At the onset of the disease, all patients had chest tightness and shortness of breath; two patients had a fever, and the markers of myocardial injury increased. Cardiac color Doppler ultrasound indicated that left ventricular ejection fraction decreased significantly. Cardiac insufficiency with cardiogenic shock rapidly appeared as the main manifestation. Two patients immediately started veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and ECMO was also started in one patient after a pacemaker placement was ineffective. For all three patients, high-dose hormones were given to control the primary disease, and then the ECMO machines were removed successfully.
VA-ECMO treatment should be implemented in patients with hemodynamically unstable LM as soon as possible to maintain the patient's hemodynamics and help them overcome the crisis of cardiac dysfunction, allowing more time for primary disease treatment.
分析3例血流动力学不稳定的狼疮性心肌炎（LM）患者的临床表现及治疗情况。
收集2018年1月至2021年12月在上海交通大学医学院附属仁济医院南院急诊重症监护病房收治的3例血流动力学不稳定的LM患者的临床资料并进行分析，同时复习相关文献。
3例患者中，2例为系统性红斑狼疮首次发病。另1例既往有混合性结缔组织病，狼疮为该疾病的主要表现。发病时，所有患者均有胸闷、气短；2例患者发热，心肌损伤标志物升高。心脏彩色多普勒超声显示左心室射血分数显著降低。以心源性休克为主的心脏功能不全迅速出现。2例患者立即开始行静脉-动脉体外膜肺氧合（VA-ECMO）治疗，1例患者在起搏器置入无效后也开始行ECMO治疗。3例患者均给予大剂量激素控制原发病，随后成功撤除ECMO机器。
对于血流动力学不稳定的LM患者，应尽早实施VA-ECMO治疗，以维持患者血流动力学，帮助其克服心功能障碍危机，为原发病治疗争取更多时间。
