完全性房室传导阻滞的转归  

Study on Transformation of Complete Atrioventricular Block in Children

作　　者：郑孝清[1] 巫平利[1] 李佩玲[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院儿科,武汉430022

出　　处：《实用儿科临床杂志》2005年第3期229-230,共2页Journal of Applied Clinical Pediatrics

摘　　要：目的　探讨小儿完全性房室传导阻滞 (CAVB)的临床转归特点 ,旨在提高其诊治水平。方法　对 1 7例初诊为CAVB患儿进行回顾性及随访研究 ,并对临床特点、治疗方案及预后进行分析。结果　先天性CAVB中 4例随访 6个月～ 9年 ,均无明显症状 ,可正常生活 ,1例因腹泻诱发阿斯综合征。病毒性心肌炎VM致CAVB中 3例经综合治疗后转为窦性心律 ,2例持续存在且伴心脏扩大 ;1例病情恶化放弃抢救 ;1例死亡。 5例心内直视术后致暂时性CAVB中 3例分别于术后较短期内转为窦性心律 ,2例永久性CAVB安置起搏器 ,其中随访 8年 1例 ,期间换过 1次起搏器 ,现能正常生活 ,另 1例失访。结论　本组先天性CAVB其QRS间期正常 ,无明显症状者无须治疗 ,但需随访。当伴心脏畸形、宽QRS波及婴幼儿不能耐受过慢心室率者为高危患儿。VM致CAVB患儿易发生阿斯综合征 ,需积极治疗。心脏直视术引起CAVB部分病例通常在术后 2～ 4周可恢复正常窦性心律。术后CAVB若持续在 4周以上、有阿斯综合征发作者需安置永久起搏器。Objective To observe the transformation features of children with complete atrioventricular block(CAVB), and to improve the diagnosis and treatment of this disease.Methods Seventeen children with primary diagnosis of CAVB were reviewed by retrospective and follow-up study and the clinical characteristics, treatment schemes and prognosis were evaluated.Results Four cases of congenital CAVB lived normally without obvious symptoms in the tracing period from 6 months to 9 years;1 case had the onset of Adams-Stokes syndrome induced by diarrhea;3 cases of the CAVB caused by virus myocarditis turned into sinus rhythm after comprehensive therapy;2 cases persistently presented with the CAVB Complicated with enlarged heart;1 case gave up treatment after deterioration, and one case died.Three cases of temporary CAVB after the open heart operation turned to sinus rhythm in transitory time, while other two cases presented with permanent CAVB and treated with epicardium pacemaker,among whom one had the pacemaker replaced for one time in the 8-year follow-up,and the follow-up of other cases were intermitted.Conclusions The congenital CAVB in the study group with normal QRS interphase and no obvious symptom might not require treatment but follow-up is needed. While infants with heart malformation and wide QRS wave could not endure the low ventricular rhythm are in high risk. Virus myocarditis induced CAVB children tend to present the Adams-Stokes syndrome, and require effective treatments. Partial cases of the CAVB caused by open heart operation may turn to normal sinus rhythm in 2-4 weeks after surgery. cases has persistent CAVB for over 4 weeks, or Adams-Stokes syndrome onset after the surgery demand epicardium pacemaker treatment.

关 键 词：房室传导阻滞 完全性 转归 儿童 

分 类 号：R725.4[医药卫生—儿科]