小儿快速型心律失常240例临床分析  

Clinical analysis of the tachyarrhythmia in 240 children

作　　者：李小梅[1] 郭宝静[1] 张宏艳[1] 丁燕生[1] 任自文[1] 李万镇[1] 刘丰 刘雪芹[1] 

机构地区：[1]北京医科大学第一医院儿科,100034

出　　处：《中华儿科杂志》2000年第9期556-559,共4页Chinese Journal of Pediatrics

摘　　要：目的　探讨小儿不同类型心动过速的构成比、相应的临床特点和体表心电图 (ECG)特征。方法　对 1985年 3月～ 1999年 4月经我院心内电生理检查确诊为快速型心律失常的 2 40例患儿进行分析 ,其中 2 2 9例经射频消蚀证实。结果　 (1) 2 40例患儿中 ,2 15例为室上性心动过速 (SVT) ;2 5例为特发性室性心动过速 (IVT)。 2 15例SVT中 ,16 4例为旁道参与的房室折返性心动过速 (AVRT) ,其中显性旁道 10 3例 ,隐匿性旁道 5 9例 ,持续性交界区反复性心动过速 (PJRT) 2例 ;房室结折返性心动过速 (AVNRT) 39例 ,房性心动过速 8例 ,心房扑动 4例。 5 9例隐匿性房室旁道中 ,7例心动过速时体表ECG逆传P波与QRS波重叠或紧随其后 ,与AVNRT无法鉴别。 2 5例IVT心室速率 15 0～ 2 40(198± 2 6 )次 min ,QRS波时限 0 .0 9～ 0 .12 (0 .11± 0 .0 1)s,2 0例有室房分离。 19例室性心动过速 (VT)起源于左心室 ,6例起源于右心室流出道。 (2 ) 2 40例中 ,9例合并器质性心脏病 ,分别为Ebstein畸形、室间隔缺损、动脉导管未闭、心内膜弹力纤维增生症和心肌炎。 9例因心动过速持续发作而并发心动过速性心肌病 ,其中 4例经射频消蚀成功治疗后心脏各项指标恢复正常。结论　 (1)AVRT和AVNRT是小儿室上性心动过速中最常见的两种类型 ;Objective To investigate the component ratio of the various types of supraventricular tachycardia (SVT), the clinical features and the surface ECG findings in children. Methods Two hundred and forty children hospitalized from March 1985 through April 1999 in First Hospital, Beijing Medical University were diagnosed as tachyarrhythmia by intracardiac electrophysiology examinations. Of the 240 cases, 229 were confirmed to have tachyarrhythmia by catheter ablations. Results Two hundreds and fifteen of 240 children were diagnosed as SVT, 25 of 240 children as idiopathic ventricular tachycardia (IVT). One hundred and sixty four of 215 children had atrioventricular reentry tachycardia (AVRT) with a bypass tract, of whom 103 as Wolff Parkinson White syndrome (WPW), 59 as unidirectional retrograde accessory pathway (URAP) and 2 had permanent form of junctional reciprocating tachycardia (PJRT). Thirty nine of 215 children had reentry with atrioventricular node, 8 had atrial tachycardia and 4 had atrial flutter. Nine children with tachyarrhythmias were accompanied with structural heart diseases, which included Ebstein's anomaly, ventricular septal defect (VSD), patent ductus arteriosus (PDA) endocardial fibroelastosis and myocarditis. Nine cases had cardiomyopathy induced by incessant tachycardia, of whom 4 recovered by the treatment with radiofrequency catheter ablations. The surface ECG during tachycardia could not differentiate URAP from the atrioventricular node reentrant tachycardia (AVNRT) in 7 patients. In 25 children with IVT, the QRS rates ranged from 150 to 240 times per minute, and QRS duration from 0.09 to 0.12 seconds. There were separations between the ventricle and the atrium in 20 of 25 IVT children. The ventricular tachycardia in 19 children originated from the left ventricles and in 6 children from the outflow tract of the right ventricle. Conclusions (1) AVRT and AVNRT were the common types of SVT in children. (2) The analysis of the correlation between P wave and QRS complex during tachycardia

关 键 词：电生理学 儿童 心动过速 体表心电图 

分 类 号：R725.4[医药卫生—儿科]