不同类型胎儿心律失常的临床近远期预后分析  

Short-and Long-Term Clinical Prognoses of Various Types of Fetal Arrhythmia

作　　者：常惠婷[1,2] 李辉[1] 

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110004 [2]中南大学湘雅医学院附属海口医院,海南海口570208

出　　处：《实用妇产科杂志》2012年第11期950-953,共4页Journal of Practical Obstetrics and Gynecology

基　　金：教育部高等学校博士学科点专项科研基金(编号:20092104110011);辽宁省科学技术计划项目(编号:2011225017)

摘　　要：目的:对胎儿心律失常孕妇进行随访,分析其近远期预后,为临床工作提供参考。方法:回顾性分析2004年4月至2010年12月于中国医科大学附属盛京医院进行胎儿心脏超声检查诊断为胎儿心律失常的541例孕妇的临床资料,并进行追踪随访。结果:①541例胎儿心律失常孕妇中,胎儿期前收缩303例(56.01%);快速胎儿心律失常196例(36.23%),其中窦性心动过速92例,室上性心动过速101例,心房扑动3例;胎儿心动过缓42例(7.76%),其中房室传导阻滞8例,窦性心动过缓34例。②共随访391例,失访150例,随访时间1～5年。其中合并胎儿心脏结构异常18例(3.33%),随访15例,有14例终止妊娠放弃胎儿;未合并胎儿心脏结构异常孕妇中有3例因出现胎儿水肿、心力衰竭终止妊娠;不愿承担风险自愿选择终止妊娠10例,分别为室上性心动过速1例,心房扑动2例,房室传导阻滞4例,严重窦性心动过缓3例。产前给予药物治疗共10例,8例有效,2例无效出现胎儿水肿终止妊娠。③共计364例患者继续妊娠,其中期前收缩的胎儿211例,后随访仅1例转归异常;快速胎儿心律失常中窦性心动过速65例和室上性心动过速67例均无转归异常;胎儿心动过缓21例,仅1例于新生儿期死亡。转归正常的患儿生长发育情况等同于正常同龄儿,预后良好。结论:胎儿心律失常类型多样,预后不同,应根据具体类型决定个体化治疗和临床处理方案。发生胎儿心力衰竭、水肿和合并有心脏畸形时,提示预后不良,需要积极进行临床干预,必要时终止妊娠放弃胎儿。胎儿期前收缩临床上最常见,其和胎儿窦性心动过速、室上性心动过速的预后较好。Objective：Analysis of the short-term and long-term prognoses of various types of fetal arrhyth- mia. Methods：541 cases diagnosed of fetal arrhythmia in Shengjing Hospital from April 2004 to December 2010 were enrolled ,and the short-term and long-term prognoses of these cases were followed up. Results： ①541 cases with fetal arrhythmia included 303 cases of premature contraction（56.01% ） ,196 cases of rapid fetal arrhythmia（36.23% ）, in which 92 cases were sinus tachycardia, 101 cases were supraventricular tachy- cardia, and 3 cases were fetal atrial flutter, and 42 cases of fetal bradycardia（7.76% ）, in which 8 cases were atrioventricular conduction block, and 34 cases were sinus bradycardia. ②391 cases were followed up with the period ranged from 1 to 5 years, and 150 cases were lost to follow-up. 15 of 18 cases combined with car- diac structural abnormalities were followed up,and 14 cases chose induction of labor. 3 of cases without car- diac structural abnormalities chose induction of labor because of edema and heart-failure; 10 cases chose in- duction of labor because of parents＇ anxiety. 10 cases received medication treatment, and 8 cases got better, and 2 cases received abortion. ③364 cases continued pregnancy. 211 cases were premature contraction, and only 1 case had an abnormal prognosis. 65 cases of sinus tachycardia and 67 cases of supraventricular tach- ycardia showed no abnormal prognosis. 21 cases were fetal heartbeat bradycardia, and only 1 baby died inthe neonatal period. Conclusions： Fetal arrhyhtmia has various types with differernt prognosis. Individual treatment and clinical scheme should beintroduced to the specific types. When heart failure and edema oc- cur,the prognosis is poor and active treatment and followed-up are required. The termination of pregnancy may be necessary if the treatment shows no effect. Premature contraction is the most common type with good prognosis ,and clinical intervention is usually unnecessary.

关 键 词：胎儿 心律失常 水肿 心力衰竭 心脏畸形 

分 类 号：R714.5[医药卫生—妇产科学]