特发性室性心动过速36例  

Thirty-Six Children with Idiopathic Ventricular Tachycardia

作　　者：王勤[1] 袁越[1] 

机构地区：[1]首都医科大学附属北京儿童医院心脏中心,北京100045

出　　处：《实用儿科临床杂志》2007年第13期980-981,989,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨儿童特发性室性心动过速(IVT)的临床特点及诊治方法。方法对2003年11月～2006年12月在北京儿童医院住院确诊为IVT的36例患儿的临床表现、实验室检查及治疗方法进行回顾性分析,并进行统计学处理。结果IVT以年长儿童多见,平均年龄7岁8个月,男女比例为1.11,根据起源部位分为左室间隔部室速(ILVT)和右室流出道室速(RVOTVT),心电图表现以右束支阻滞形态为主23例(63.8%),为左室型室速;呈左束支阻滞图形13例(36%),为右室型室速。左室型23例中胸闷、心悸15例(41.6%),晕厥发作2例(5.5%);右室型13例中心悸3例(8.3%),乏力1例(2.7%),余9例(25%)无明显临床症状。左室型室速临床表现较右室型室速重,二者比较差异有显著意义(P<0.01)。左室型室速6例(15次)用维拉帕米有效,10例(17次)使用普罗帕酮有效,1例(1次)使用胺碘酮有效,2例(3次)行体外同步直流电击复律有效。右室型1例(1次)使用艾司洛尔有效,3例(2次)使用普罗帕酮有效。23例(63%)行射频消融治疗,室速消失。行射频消融治疗病例较长期服药的复发率低,二者比较差异有显著意义(P<0.01)。结论IVT临床表现大多较轻,但亦有心力衰竭和晕厥发作,准确分型有利于准确用药,射频消融为较好治疗方法。Objective To study the clinical characteristics and therapy of children with idiopathic ventricular tachycardia（IVT）. Method Clinical features,laboratory examination, treatment and outcomes of cases involving 36 children with IVT were retrospectively and statistically analysed . Results IVT often happened in teenagers. The average age of selected patients was 7 years and 8 months, and the ratio of male and female was 1.1 ： 1. Electrokardiogram（EKG） results showed 23 cases（63.8% ） were VT that arised from the left ventricular tachycardia （ILVT） with right bundle branch block,and 13 cases（36% ） were VT that arise from the right ventricular outflow tract （RVOT VT） with left bundle branch block. Among the 23 children with tachycardia, 15 children had palpitation ,2 children had syncope. Of the 13 children with right ventricular tachycardia,3 children had increased heartbeat, and 1 child suffered from weakness, others had no significant clinical symptoms. Cases with ILVT had more serious clinical symptoms than cases with right ventricular tachycardia. It was of marked significance to compare their differences（ P 〈0.01 ）. Of the 23 cases with ILVT, verapamil was effective in 6 cases 15 times ;propafenone was effective in 10 case 17 times; amiodarone was effective in 1 case one time;electrical cardioversion was effective in 2 cases 3 times. Of the 13 cases with right ventricular tachycardia, esmolol was effective in 1 case one time;propafenone was effective in 3 cases 2 times, lidocaine was ineffective in 2 cases 5 times. Radiofrequency ablation therapy was used in 23 patients（63% ） ,and their ventricular tachycardia disappeared. Radiofrequency ablation therapy had a lower recurrence rate than long - term use of medication. It was of marked significance to compare the differences of the 2 therapies（P 〈0.01 ）. Conclusions The clinical symptoms of IVT are often slight, however, heart failure and syncope can happen sometimes. Accurate typing is helpful drug therapy. Radiofrequency

关 键 词：特发性室性心动过速 诊断 治疗 儿童 

分 类 号：R725.4[医药卫生—儿科]