多学科联动救治暴发性心肌炎患者的反思

Reflection on multidisciplinary collaborative treatment of a patient with fulminant myocarditis

摘要

暴发性心肌炎是临床最为危重的心肌炎类型，以心肌弥漫性炎症损伤为核心病理特征，病情常急骤进展为心源性休克与多器官功能衰竭，病死率高达 40%～50%，其救治是重症医学领域的重大挑战。2025 年，福建医科大学附属第一医院依托多学科团队（MDT）联动，成功救治暴发性心肌炎患者 6 例。本文以 1 例 46 岁男性暴发性心肌炎合并肝功能不全、电解质紊乱及肺部感染的复杂病例为叙事主线，系统疏理 MDT 联动下清醒静脉-动脉体外膜肺氧合（VA-ECMO）支持、精准血压管理、多器官功能协同保护的全流程救治策略，深入阐释 MDT 在暴发性心肌炎等急危重症救治中的协同机制与实践价值，通过对救治过程的深度复盘与反思，提炼关键技术环节，优化临床诊疗思路，旨在为同类疾病的规范化与个体化救治提供高质量临床参考，进一步夯实暴发性心肌炎“生命支持-病因治疗-功能康复”一体化救治模式的实践基础。

Abstract

Fulminant myocarditis is the most critical clinical type of myocarditis, with diffuse inflammatory injury of the myocardium as its core pathological feature. The patient’s clinical condition often progresses rapidly to cardiogenic shock and multiple organ failure, with a mortality rate as high as 40%–50%. Its treatment represents a major challenge in the critical care medicine. In 2025, six patients were treated successfuly with fulminant myocarditis through multidisciplinary team (MDT) collaboration in the First Affiliated Hospital of Fujian Medical University. Based on the narrative of a complex case of a 46-year-old male patient with fulminant myocarditis complicated by hepatic insufficiency, electrolyte disturbance and pulmonary infection, this paper systematically summarizes the whole-process treatment strategies including awake veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support, precise blood pressure management, and collaborative protection of multiple organ functions under MDT cooperation. It further elucidates the synergistic mechanism and practical value of MDT in the treatment of critical illnesses such as fulminant myocarditis. This paper reviewed in-depth and shared the experience of the treatment process. Key technical points are refined and clinical diagnosis and treatment ideas are optimized, aiming to provide high-quality clinical references for the standardized and individualized treatment of similar diseases. Consolidate the foundation of the integrated “life support−etiologic treatment−functional rehabilitation” rescue model for fulminant myocarditis.

关键词

暴发性心肌炎 / 多学科团队联动 / 清醒静脉-动脉体外膜肺氧合 / 精准血压管理 / 多器官功能保护

Key words

fulminant myocarditis / multidisciplinary team collaboration / awake veno-arterial extracorporeal membrane oxygenation / precise blood pressure management / multiple organ function protection

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