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\"秋季小儿腹泻

长期以来，人们普遍认为小儿感冒时容易并发小儿病毒心肌炎，而秋冬季腹泻病患儿一般不会引起病毒性心肌炎，其实不然。前些年，重庆医科大学附属儿童医院对242例轮状病毒性肠炎患儿进行临床研究，结果发现，该组病例有133例（占54.96%）合并病毒性心肌炎，值得家长们引起高度重视。

 

小儿病毒心肌炎系指因病毒感染引起的心肌细胞变性、坏死和间质炎症，多伴有不同程度的心功能障碍。本病高发于2-12岁的儿童，这是由于儿童的免疫系统发育不完善，尚处于调整状态，心肌组织容易遭到病毒的攻击，导致心肌炎的发生。

 

小儿病毒性心肌炎的临床症状轻重极为悬殊，轻者可无明显自觉症状，严重者可在1-2日内出现心功能不全或突发心源性休克，甚至猝死。

 

由于轮状病毒所致的病毒性心肌炎发生率较高，儿科专家建议，对患上秋冬季腹泻的孩子应早期做心电图检查及检测心肌酶谱，及早做出恰当的治疗，减轻心肌损伤程度，还可避免心源性猝死。


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\"小儿心肌炎应注意什么\"

对于患了病毒性心肌炎的患儿家长应该注意些什么呢？首先，不要产生过重的精神压力，要使孩子树立战胜疾病的信心。要知道，现代医学的发展和进步，可使绝大多数的患儿得到治疗，相当一部分患儿可以完全治愈仅有极少数的患儿会发展成为慢性心肌炎或扩张型心肌病。其次，要让患儿尽量卧床休息，吃易消化的食物，多吃水果。第三，积极配合医生进行治疗。一般病毒性心肝岂炎在医院治疗大约3周时间，然后可以在家治疗。由于病毒对心脏损害的特殊性，其恢复期要长于病毒对其它脏器的损害，一般为3个月到半年。部分患儿在此期间因不愿意耽误课程，会坚持到学校学习，但要注意不要过于劳累，适当限制体力活动，并且要定期到医院复查。


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当肌体免疫力低下或再次受到病毒等致病因素侵袭时，心脏将再次受到冲击，久而久之，病情不断迁延及反复，心肌发生不可逆转的病理改变，就可转化为心肌病。心肌炎治疗不可拖延。

\"心肌炎治疗不可“拖泥带水”\"

 

心肌炎与心肌病的预后截然不同，一般说来，心肌炎是可以治愈的，而心肌病因其病理改变呈进行性恶化，难以逆转，预后较差。因此防止心肌炎转化为心肌病具有非常重要的意义。心肌炎切不可“拖泥带水”。

 

心肌炎治疗不可拖延，做到以下几点是非常重要的。

 

1、及时正规治疗。确诊后，治疗要及时、准确、正规。病情好转后，要定期随诊、复查，长期坚持治疗。

 

3、尽量注意休息。确诊后，应立即卧床休息，坚持一个月左右。对于疑似心肌炎患者，也应及早限制活动，定期随访观察。病情好转后，应逐渐增加活动量，避免剧烈运动及过度劳累。

 

4、防治并发感染。除采取一般性预防措施之外，对于免疫功能低下者，可适当应用免疫调节剂、免疫增强剂或中药。有慢性感染灶者应在适当时予以清除。除应预防呼吸道感染外，还应注意消化道的感染，因为心肌炎的致病病毒如柯萨奇A、柯萨奇B、ECHO病毒等均为肠道感染病毒。

 

5、饮食要注意均衡营养。合理饮食，保证足够的热量、蛋白质、各种维生素、矿物质及微量元素的摄入，切忌偏食、择食、饥饱无常或暴饮暴食。


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\"预防小儿心肌炎

在心肌炎中，病毒性心肌炎占了60%-70%以上，而病毒性感冒与病毒性心肌炎的关系可以说是密不可分。引起感冒的许多病毒，如流感病毒、腺病毒、柯萨奇病毒、Echo病毒等同样会引起心肌炎。这些病毒本身会攻击人体的上呼吸道，也同样会攻击心肌细胞。而且人体免疫的代谢物———细胞因子对我们的心肌细胞也有损害。一般在感冒高发季节，心肌炎的发病率也会明显上升。特别是小孩子特别容易患心肌炎。

 

　　预防小儿心肌炎怎么办?

 

　　一、要根据气温变化来给小儿增减衣物，预防感冒，同时加强身体锻炼，增强抗病能力，中医所谓“正气存内，邪不可干”。

 

　　二、80%的心肌炎复发病人患有慢性咽炎、慢性扁桃体炎、慢性鼻炎，因此积极治疗上述疾病是防止心肌炎复发的重要措施。

 

　　三、对于上学的小朋友来说，平时要注意劳逸结合、生活规律，避免功课过劳，因为心脏是最怕劳累的器官之一。

 

　　四、在饮食调理方面，要合理饮食，不暴饮暴食，少吃烧、烤、煎、炸食品，多食新鲜蔬菜水果，在患病时要注意避免使用可能有心脏毒性的药物，平时也可根据个人的体质用中药汤水食疗调理，最好在中医师当面望闻问切后辨证指导食疗。


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\"专家向您解答

找良医网向您详细介绍小儿心肌炎应该如何鉴别诊断。

 

小儿心肌炎鉴别

 

病毒性心肌炎主要应与以下疾病鉴别：

 

1.风湿性心肌炎

多见于5岁以后学龄前和学龄期儿童，有前驱感染史，除心肌损害外，病变常累及心包和心内膜，临床有发热、大关节肿痛、环形红斑和皮下小结，体检心脏增大，窦性心动过速，心前区可听到收缩期反流性杂音，偶可听到心包摩擦音。抗链“O”增高，咽拭子培养A族链球菌生长，血沉增快，心电图可出现一度房室传导阻滞。

 

2.受体功能亢进症

多见于6～14岁学龄女童，疾病的发作和加重常与情绪变化(如生气)和精神紧张(如考试前)有关，症状多样性，但都类似于交感神经兴奋性增高的表现。体检心音增强，心电图有T波低平倒置和S-T改变，普萘洛尔试验阳性，多巴酚丁胺负荷超声心动图试验心脏受体功能亢进。

 

3.先天性房室传导阻滞

多为三度阻滞，患儿病史中可有晕厥和Adams-Stokes综合征发作，但多数患儿耐受性好，一般无胸闷、心悸、面色苍白等。心电图提示三度房室传导阻滞，QRS波窄，房室传导阻滞无动态变化。

 

4.自身免疫性疾病

多见全身型幼年型类风湿性关节炎和红斑狼疮。全身型幼年型类风湿关节炎主要临床特点为发热、关节疼痛、淋巴结、肝脾肿大、充血性皮疹、血沉增快、C反应蛋白增高、白细胞增多、贫血及相关脏器的损害。累及心脏可有心肌酶谱增高，心电图异常。对抗生素治疗无效而对激素和阿司匹林等药物治疗有效。红斑狼疮多见于学龄女童，可有发热，皮疹，血白细胞、红细胞和血小板减低，血中可查找到狼疮细胞，抗核抗体阳性。

 

5.皮肤黏膜淋巴结综合征

多见于2～4岁幼儿，发热，眼球结膜充血，口腔黏膜弥散性充血，口唇皲裂，杨梅舌，浅表淋巴结肿大，四肢末端硬性水肿，超声心动图冠状动脉多有病变。需要注意的是，重症皮肤黏膜淋巴结综合征并发冠状动脉损害严重时，可出现冠状动脉梗死心肌缺血，此时心电图可出现异常Q波，此时应根据临床病情和超声心动图进行鉴别诊断。


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