胎儿期心律失常的诊断及其对新生儿预后的影响  

Diagnosis and the clinical significance of fetal arrhythmias

作　　者：叶海慧[1] 梁秀珍[1] 王正平[1] 

机构地区：[1]浙江大学医学院附属妇产科医院产科,浙江杭州310006

出　　处：《中国实用妇科与产科杂志》2008年第12期919-921,共3页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：浙江省教委基金资助项目(20040239)

摘　　要：目的了解胎儿期心律失常的诊断方法、临床意义及对新生儿预后的影响。方法选择2004年6月至2006年1月于浙江大学医学院附属妇产科医院产前检查中发现胎儿心律失常孕妇57例,分析孕妇病史、胎儿心电图、胎儿超声心动图、妊娠结局。结果胎儿心律失常中胎儿心动过速、胎儿心动过缓和不规则胎儿心律的构成比分别为17.4%、4.3%和78.3%。首次发现胎儿心律失常的孕周及胎儿心律失常的类型与新生儿预后没有显著关联。持续发作心律失常的胎儿,其预后显著差于偶发心律失常的胎儿。经期待疗法,孕期胎儿心率恢复正常的有21例(36.8%),出生后新生儿心率迅速恢复正常的有15例(26.3%),经对症治疗后有14例新生儿恢复正常心率(24.6%)。发现4例(7.0%)胎儿心脏结构异常。59.7%的孕妇合并产科并发症。结论大部分心律失常的胎儿预后良好,在临床上可以密切随访,可在分娩前或出生后恢复正常心率;与胎儿预后不良有关的因素为持续发作心律失常、胎儿伴有水肿。Objecive To evaluate the diagnosis of fetal arrhythmias and explore its clinical significance and correlation with fetal prognosis. Methods Fifty-seven cases of fetal arrhythmias were examined from July 2004 to Jan 2006 in Woman＇s Hospital, School of Medicine, Zhejiang University. The medical histories of mother, fetal electrocardiograph, echocardiography and pregnant results were analyzed. Results In 57 cases with fetal arrhythmias, 17.4% of them were diagnosed as fetal tachycardia, 4. 3% of them were diagnosed as fetal bradycardia and 78. 3% of them were diagnosed as irregular fetal cardiac rhythm. There was no significant correlation between fetal prognosis and the gestational age they were diagnosed as arrhythmias and the type of fetal arrhythmias. The prognosis of these persistant arrhythmia fetuses was worse significantly than that of these fetuses with arrhythmias accidentally. Without special treatment, 21 cases（ 36. 8% ） recovered with normal heart rate and rhythm during pregnant period and 15 cases （36. 8% ） recovered with normal heart rate and rhythm postnatally; 14 neonates （24. 6% ） recovered with normal heart rate and rhythm; 4 （7.0%） cases were diagnosed as structural heart disease. The incidence of cases with pregnant complications was 59. 7%. Conclusion The prognosis is good for most of the fetuses with arrhythmias. Temporization for the management of arrhythmatic fetuses should be accepted. Most fetal arrhythmias could recover to normal during pregnant period or postnatally. Negative prognostic factors are associated with persistent arrhythmias and hydrops fetalis.

关 键 词：胎儿 心律失常 

分 类 号：R71[医药卫生—妇产科学]