儿童T波电交替的临床研究  

A clinical study of T-wave alternans in pediatric patients

作　　者：曾少颖[1] 石继军[1] 张智伟[1] 李渝芬[1] 叶钜亨[1] 

机构地区：[1]广东省人民医院广东省心血管病研究所儿科,510080

出　　处：《中国小儿急救医学》2009年第4期340-343,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的 探讨T波电交替（T-wave altemans，TWA）的病因及预防恶性室性心律失常和心源性猝死的方法。方法回顾性分析6例心电图TWA阳性患儿诊治的过程。例1为急性重症心肌炎；例2为特发性左室室性心动过速患儿因长时间大剂量使用乙胺碘呋酮后，导致获得性长QT综合征；例3为先天性长QT综合征；例4为先天性心脏病主动脉缩窄纠治术后心肌梗死；例5、例6为心率增快的先天性重度主动脉瓣狭窄。结果6例均出现心电图刑A，其中5例即时或几小时后出现室性心动过速。2例通过治疗，TWA消失，未出现室性心动过速；另外4例未积极预防室性心动过速的发生而死亡。结论TWA是室性心动过速、心室颤动及心源性猝死的先兆，应引起临床重视；对于TWA阳性患儿，除了明确病因，积极治疗原发病外，应高度警惕恶性室性心律失常的发生，另外积极预防TWA的出现也尤为重要。Objective To investigate the cause of T-wave altemans in pediatric patients, and prevent malignant ventricular arrhythmia and sudden cardiac death. Methods We retrospectively analyzed the treating process of 6 pediatric patients with T-wave altemans. Case 1 was a child with acute serious myocarditis. Case 2 was a child with idiopathic left ventricular tachycardia, and had acquired long-QT syndrome after treated with large dose of amiodarone for a long time by unclear diagnosis. Case 3 had congenital long-QT syndrome. Case 4 was a child with myocardial infarction after correction of coarctation of aorta for 5 months. Case 5 and case 6 were children who hade increasing heart rate with severe congenital stenosis of aortic valve. Results All of 6 cases occurred T-wave alternans, and 5 of them occurred malignant ventricular arrhythmia instantly or after several hours. In 2 cases,T-wave altemans disappeared and malignant ventricular arrhythmia did not occurred through prevention and treatment. The other 4 cases died without active prevention for malignant ventricular arrhythmia. Conelusion T-wave altemans is presymptom of malignant ventricular arrhythmia and sudden cardiac death. We should take notice of occurrence of malignant ventricular arrhythmia in pediatric patients with T-wave alternans and diagnosing and treating correctly for primary disease. It is of great importance to prevent occurrence of T-wave altemans.

关 键 词：儿童T波电交替 猝死 恶性室性心律失常 

分 类 号：R725.4[医药卫生—儿科]