经胎盘转运地高辛治疗胎儿快速心律失常6例临床分析  

Transplacental digoxin treatment for fetal tachycardia: a clinical analysis

作　　者：杨冬[1] 李燕娜[1] 张豪锋[1] 刘晓伟[2] 韩玲[3] 何怡华[2] 郭宝静 张军[1] YANG Dong;LI Yanna;ZHANG Haofeng;LIU Xiaowei;HAN Ling;HE Yihua;GUO Baojing;ZHANG Jun(Obstetrics And Gynecology Medical Center Of Severe Cardiovascular Disease Of Beijing,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所妇产科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所超声诊断科,100029 [3]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏科,100029

出　　处：《心肺血管病杂志》2018年第11期985-988,1001,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:评价经胎盘转运地高辛治疗胎儿室上性心动过速(SVT)和心房扑动的疗效。方法:回顾性分析2016年1月至2017年12月,首都医科大学附属北京安贞医院收治并经胎盘转运地高辛治疗的3例胎儿SVT和3例心房扑动的临床资料。所有孕妇口服地高辛剂量为0. 125mg、每天1～2次,3d后以0. 125mg或0. 25mg,每天2次维持治疗。l周为1疗程。每周监测母体外周血地高辛浓度及胎儿超声心动图检查,维持胎儿心脏指标基本正常或至孕妇分娩。结果:胎儿水肿:6例胎儿中4例(66. 7%)存在胎儿水肿; CVPS评分:1例9分,5例≤6分;疗效:经地高辛治疗后,2例治疗有效,1例病情改善,3例治疗失败;妊娠结局:2例家属放弃治疗并行利凡诺羊膜腔注射中期引产术,4例行剖宫产术分娩活婴(其中3例足月儿,1例早产儿);新生儿结局:4例活产儿随访3～18个月,生长发育符合生长曲线,未发生心律失常。结论:经胎盘转运地高辛治疗胎儿SVT和心房扑动有一定疗效。Objective:To evaluate the effect and value of transplacental digoxin therapy for fetal supraventricular tachycardia(SVT)and atrial flutter(AF).Method:We retrospectively analyzed the clinical data of three fetuses with SVT and three fetuses with AF who received transplacental digoxin therapy at Beijing AnZhen Hospital,Capital Medical University from January2015to December2017.The pregnant women were given0,,125mg digoxin once or twice daily for three days,then0,,125mg or0,,25mg once or twice daily for one week.Maternal serum digoxin concentration and fetal echocardiography were closely detected per week.Digoxin was used until fetal cardiac index was stabilized or pregnancy was terminated.Results:There were four cases with hydrops fetalis,in which one‘s CVPS was9points and the others’were less than six points.After treated with digoxin,the obvious effectiveness has been documented in two foetuses,clinical improvement in1fetus,and treatment failure in3foetuses.Two fetuses were induced labor with rivanol.The four fetuses were delivered by caesarean section,in which three at term and one at preterm.Arhythmia has not been documented in4babies during follow-up.Conclusion:Transplacental digoxin therapy has a certain effect in treating fetal SVT and AF.

关 键 词：胎儿心律失常 胎盘转运地高辛 

分 类 号：R54[医药卫生—心血管疾病]