儿童快速型心律失常107例临床诊治分析  

Clinical diagnosis and treatment of tachyarrhythmia in 107 pediatric patients

作　　者：徐萌[1] 肖婷婷[1] 沈捷[1] 黄敏[1] 谢利剑[1] 王健怡[1] 

机构地区：[1]上海市儿童医院上海交通大学附属儿童医院心内科,上海200062

出　　处：《临床儿科杂志》2016年第4期258-263,共6页Journal of Clinical Pediatrics

摘　　要：目的探讨儿童快速型心律失常的临床诊断、治疗及预后。方法回顾性分析2011年1月至2014年12月收治的107例快速型心律失常患儿的临床资料,按住院24 h动态心电图中室上性快速型心律失常占总心率50%以上或室性心动过速占10%以上分为无休止性组和间歇性发作组,比较两组患儿的临床特征。结果 107例患儿中,男64例、女43例。31例无休止性组中位年龄7个月,包括阵发性室上性心动过速(PSVT)13例、房性心动过速(AT)13例、紊乱性房性心动过速(CAT)2例、房颤1例、交界性异位性心动过速(JET)1例和室性心动过速(VT)1例,发展为心动过速性心肌病21例(67.7%);76例间歇性发作组中位年龄6岁,包括PSVT 55例、AT 4例、CAT 2例、房扑5例(合并房颤2例)、房颤1例、JET3例和VT 6例。无休止性组单药治疗14例,联合用药17例;间歇性发作组单药治疗61例,联合用药11例。两组患儿中药物不能有效控制者选择食管心房调搏术治疗17例、电击复律3例、心脏临时起搏2例及射频消融术30例。随访6个月,无休止性组2例PSVT复发,2例AT、1例房颤和1例JET控制室率;间歇性发作组7例PSVT、1例VT复发,1例房扑控制室率,PSVT、VT各放弃治疗和死亡2例,余病例均持续恢复窦性心律。两组患儿的年龄、PSVT与其他快速型心律失常例数、血清cTn I ≥0.30 ng/m L例数、血清NT-pro BNP≥250 pg/m L例数,以及单药和联合用药治疗例数的差异均有统计学意义(P < 0.05)。结论无休止性快速型心律失常治疗难度大,常需联合用药,易发展为心动过速性心肌病。Objective To discuss the diagnosis, treatment, and outcomes of pediatric tachyarrhythmia. Methods Clinicaldata of 107 pediatric inpatients with tachyarrhythmia from January 2011 to December 2014 were retrospectively analyzed.According to 24 hours holter, all patients were divided into two groups, incessant group whose supraventricular tachyrhythmiawere more than 50% of heart rate, and intermittent group whose ventricular tachycardia were more than 10%. The clinical featureswere compared between two groups. Results In a total of 107 patients （64 male and 43 female）, there were 31 cases in incessantgroup with the median age of 7 months which included 13 cases of paroxysmal supraventricular tachycardia （PSVT）, 13 cases ofatrial tachycardia （AT）, 2 cases of chaotic atrial tachycardia （CAT）, 1 case of atrial fibrillation （Af）, 1 case of junctional ectopictachycardia （JET）, and 1 case of ventricular tachycardia （VT）. Among them, 21 cases （67.7%） were progressed to tachycardiainducedcardiomyopathy. There were 76 cases in intermittent group with the median age of 6 years which included 55 cases ofPSVT, 4 case of AT, 2 cases of CAT, 5 cases of atrial flutter （AF） （2 cases combined with Af）, one case of Af, 3 cases of JET, and6 cases of VT. 14 cases received monotherapy and 17 cases received combination drug therapy in incessant group. Meanwhile,61 cases received monotherapy and 11 cases received combination drug therapy in intermittent group. In two groups, because thesymptoms of tachyarrhythmias could not be controlled effectively, 17 cases had to treat by transesophageal atrial pacing, 3 casestreated by electrical cardioversion, 2 cases treated by cardiac temporary pacing, and 30 cases treated by radiofrequency ablation.In 6 months of follow-up, one case of VT relapsed, 2 cases of AF and one case of JET controlled ventricular rate in incessantgroup, while 7 cases of PSVT and one cases of VT relapsed, one cases of AF controlled ventricular rate, and 2 cases of PSVT andVT abandoned

关 键 词：快速型心律失常 诊断 治疗 预后 儿童 

分 类 号：R725.4[医药卫生—儿科]