小儿紊乱性房性心动过速临床分析  

Clinical manifestations of childhood chaotic atrial 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,100045

出　　处：《中华实用儿科临床杂志》2014年第9期680-682,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨小儿紊乱性房性心动过速的临床特点及诊治方法。方法对2001年9月至2013年10月在北京儿童医院住院的33例紊乱性房性心动过速患儿的临床表现、实验室检查及治疗方法进行系统性回顾分析。结果33例患儿中，男23例，女10例，年龄3d～1岁1个月，平均年龄5个月，心电图均符合：P’波具有3种以上形态，P’R间期、RR间期及P’P’间期不等，P’R之间有等电位线。24h动态心电图合并心房扑动、心房颤动、房性期前收缩、房性心动过速、室内差异性传导。心脏彩超显示心脏轻度扩大19例、中度扩大4例、重度扩大3例，卵圆孔未闭12例，房间隔缺损5例，室间隔缺损3例，房间隔缺损伴动脉导管未闭、先天性完全性肺静脉异位引流各1例。有心力衰竭23例。根据心功能情况分别选择地高辛、地高辛加胺碘酮、地高辛加倍他乐克、倍他乐克治疗，2例未用抗心律失常药治疗。26例（78．8％）在出院后3～18个月心电图恢复为正常窦性心律，3例（9．1％）随访时间在12个月内心电图未恢复，心室率尚控制在正常范围。26例心脏扩大的患儿中，心脏彩超示21例（80．8％）在心电图恢复后1～3个月恢复正常，另5例（19．2％）在心电图恢复后6～12个月恢复正常。1例死亡，3例失访。结论紊乱性房性心动过速多发生于新生儿及婴儿，其诊断主要依赖于心电图及24h动态心电图，依患儿心功能情况选择洋地黄制剂及或B受体阻滞剂、胺碘酮治疗后，可转复为窦性心律，预后良好。Objective To study the clinical characteristics of children with chaotic atrial tachycardia （ CAT）, and to improve its clinical diagnosis and treatment. Methods Clinical data, follow-up, treatment and prognosis con- cerning 33 patients with CAT from Sep. 2001 to Oct. 2013 in Beijing Children＇s Hospital were analyzed. Results The 33 patients included 23 boys and 10 girls with ages ranging from 3 days to 13 months,5 months on the average. CAT was conformed by electrocardiogram in all patients ：muhifocal atrial tachycardia defined by 3 distinct P＇-waveforms, ir- regular P＇R, RR and P＇-P＇ intervals,and isoelectric baseline between P＇-waves. Combined with symptoms of atrial flut- ter, atrial fibrillation, atrial premature beats, atrial tachycardia, and interior conduction, differences were detected by 24- hour hoher electrocardiography. Echocardiographic features indicated mild heart enlargement in 19 cases, medium en- largement in 4 cases, severe enlargement in 3 cases, atrial septal defect in 5 cases, ventricnlar septal defect in 3 cases, atrial septal defect coupled with patent ductus arteriosus in 1 case, congenital total anomalous pulmonary venous connec- tion in 1 case,and patent foramen ovale closure in 12 cases. Twenty-three patients had heart failure. Digoxine, amioda- rone and Betaloc were administered to the patients for maintaining their heart functions. No antiarrhythmic drug therapy was used in 2 patients. Twenty-six of the patients （78.8%） had normal electrocardiographic sinus rhythm within 3 to 18 months after their discharge from hospital. Three of the patients （9.1%） still had CAT symptoms in their eletroccar- diogrmn, but their heart rates were kept under control during the 12-month follow-up clinical visits. Of 26 children with cardiac enlargement, echocardiograms in 21 cases （80.8%） returned to normal within 1 -3 months after their electro- cardiogranls returned to normal,and for the other 5 cases （ 19.2% ） ,the recovery took 6 - 12 months. One patient died and 3

关 键 词：紊乱性房性心动过速 诊断 治疗 JL童 

分 类 号：R725.4[医药卫生—儿科]