目的 探讨24h动态心电图(Holter)监测在病毒性心肌炎患儿诊断中的应用价值.方法 收集2016年1月至2018年6月85例病毒性心肌炎患儿的临床资料,记录患儿临床表现,均行心肌肌钙蛋白(cTn)和心肌酶指标检测,行常规心电图、Holter检查,比较上述检查对诊断病毒性心肌炎患儿心律失常诊断价值.结果 病毒性心肌炎患儿临床特征复杂多样,其中以首发胸部不适、胸痛、咳嗽、乏力、发热为多见,分别占34.12%(29/85)、29.41%(25/85)、28.24%(24/85)、25.88%(22/85)、24.71%(21/85).病毒性心肌炎患儿心律失常的类型多种多样,常规心电图、Holter单项或联合检查均以室性早搏、房性早搏、QRS低电压、Ⅰ度房室传导阻滞、ST段改变为多见.常规心电图、Holter、cTn和心肌酶、常规心电图联合Holter诊断心律失常准确性分别为75.29%、85.88%、64.71%、96.47%;结果显示,相比常规心电图、Holter、cTn和心肌酶谱检测,常规心电图联合Holter诊断心律失常准确性明显高于其它诊断方法(χ2值分别为14.02、4.68、25.42,均P<0.05).结论 病毒性心肌炎患儿的临床特征复杂多样,常规心电图是其临床常用检查方法,并且联合Holter可提高心律失常的检出准确性,值得临床应用.%Objective To analyze the clinical characteristics of children with viral myocarditis and the diagnostic accuracy of combined electrocardiogram and Holter. Methods The clinical data of 85 children with viral myocarditis from January 2016 to June 2018 were collected. The clinical manifestations of the children were recorded. The cardiac troponin(cTn)and myocardial enzymes were detected. The routine electrocardiogram and Holter were performed to compare the accuracy of the above tests in the diagnosis of arrhythmia in children with viral myocarditis. Results The clinical characteristics of children with viral myocarditis were complex and varied,among which the first chest discomfort,chest pain,cough, fatigue and fever were the most common,accounted for 34.12%(29/85),29.41%(25/85),28.24%(24/85),25.88%(22/85)and 24.71% (21/85),respectively. There were many types of arrhythmia in children with viral myocarditis. Conventional electrocardiogram,Holter single or combined examination were mainly ventricular premature beats,atrial premature beats,QRS low voltage,I degree atrioventricular block, ST segment changes. The diagnostic accuracy of conventional electrocardiogram,Holter,cTn,myocardial enzymes and Holter combined with conventional electrocardiogram in arrhythmia were 75.29%,85.88%,64.71% and 96.47%,respectively. The results showed that the diagnostic accuracy of conventional electrocardiogram combined with Holter was significantly higher than that of other diagnostic methods(χ2=14.02,4.68,25.42, respectively. all P<0.05)when compared with conventional electrocardiogram,Holter,cTn and myocardial enzymogram. Conclusion The clinical features of children with viral myocarditis are complex and varied. Conventional electrocardiogram is a commonly used clinical examination method,and combined with Holter can improve the detection accuracy of arrhythmia,which is worthy of clinical application.
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