胎儿心律失常产前治疗及管理专家指导意见  

Expert guidance on prenatal treatment and management for fetal arrhythmia

作　　者：中华医学会儿科学分会心血管学组胎儿心脏病协作组 中华医学会儿科学分会心血管学组围产期先天性心脏病诊疗协作组 周开宇 陈笋[3] 王川 李一飞 潘微[4] 赵博文[5] 张玉奇[6] 逄坤静 丁文虹[8] 任芸芸 林建华[10] 韩波[11] 吕海涛[12] 张清友[13] 武育蓉[3] 刘保民[14] 吴琳 张艳敏[16] 肖婷婷[17] 何怡华[18] 华益民 Fetal Heart Disease Cooperation Team of Pediatric Cardiorascular Group of Chinese Pediatric Sociely of Chinese Medial Association;Perinatal Congenital Heart Disease Cooperalion Team of Pediatric Cardiouascular Group of Chinese Pediatric Society of Chinese Medial Association;Zhou Kaiyu;Chen Sun;Wang Chuan;Li Yifei;Pan Wei;Zhao Borcen;Zhang Yuqi;Pang Kunjing;Ding Wenhong;Ren Yunyun;Lin Jianhua;Han Bo;Lyu Haitao;Zhang Qingyou;Wu Yurong;Liu Baomin;Wu Lin;Zhang Yanmin;Xiao Tingting;He Yihua;Hua Yimin(不详;Department of Pediatric Cardiology,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Provrince,China;Department of Pediatric Cardiology,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Maternal Fetal Cardiology,Guangdong Provincial People's Hos pital,Guangzhou 510080,Gruangdong Province,China;Department of Ultrasound,Sir Run Run Shar Hospital,Zhejiang University School of Medicine,Hangzhou 310016,Zhejiang Province,China;s Department of Pediatric Cardiology,Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Echocardiography,Fuwai Hospital Chinese Academy of Medical Sciences,.Beijing 100037,China;Department of Pediatric Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of UIltrasound,Obstetrics and Gynecology Hospital of Frudan University,Shanghai 200011,China;Department of Obstetrics and Gynecology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Pediatrics,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong Province,China;Department of Cardiology,.Children's Hospital of Soochow University,Suzhou 215025,J iangsu Province,China;Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;Department of Ultrasound,Second Affiliated Hospital of Xi an Jiaotong Unirersity,Xi'an 710004,Shaa

机构地区：[1]不详 [2]四川大学华西第二医院小儿心血管科,成都610041 [3]上海交通大学医学院附属新华医院儿童心脏中心,200092 [4]广东省人民医院母胎心脏诊疗科,广州510080 [5]浙江大学医学院附属邵逸夫医院超声科,杭州310016 [6]上海交通大学医学院附属上海儿童医学中心心脏超声中心,200127 [7]中国医学科学院阜外医院超声影像中心,北京100037 [8]首都医科大学附属北京安贞医院小儿心脏中心,100029 [9]复旦大学附属妇产科医院超声科,上海200011 [10]上海交通大学医学院附属仁济医院妇产科,200127 [11]山东省立医院儿科,济南250021 [12]苏州大学附属儿童医院心血管科,215025 [13]北京大学第一医院儿科100034 [14]西安交通大学第二附属医院超声科710004 [15]复旦大学附属儿科医院心内科,上海201102 [16]西安交通大学附属儿童医院心内科/儿研所,710003 [17]上海交通大学附属儿童医院心脏内科,200062 [18]首都医科大学附属北京安贞医院,100029

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第1期15-29,共15页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家科技部重点研发项目(2018YFC1002301、2018YFC1002300);国家自然科学基金项目(82070324、81800288);四川省科技厅重点研发项目(2020YFS0101、2019YJ0024、2021YJ0211、2021YFS0094)。

摘　　要：胎儿心律失常(FA)是产科及儿童心血管科门诊常见的胎儿疾病,约10%FA可持续存在或进展,导致重要脏器继发性损伤及胎儿心力衰竭,甚至可导致胎儿早产及死亡。在准确的产前诊断基础上,对FA的性质进行甄别,对严重FA进行及时恰当干预,改善胎儿预后,具有极大的医学及社会学意义。目前国外在FA产前干预方案制定,以及治疗药物评价等方面均取得较多进展,但是国内相关研究尚较少,不同研究对FA的产前治疗及管理差异均较大。为提高中国儿科及围生医学科医师对FA产前管理认识,严格把控FA临床治疗适应证,规范治疗策略,推动FA产前干预在国内的健康良性发展,中华医学会儿科学分会心血管学组胎儿心脏病协作组、围产期先天性心脏病诊疗协作组组织相关专家,结合国内外FA产前治疗及管理的最新研究进展与国内实际,经过充分讨论,对我国FA产前干预指征、干预策略、药物治疗选择等,达成初步共识后,制定《胎儿心律失常产前治疗及管理专家指导意见》。但是,目前国外关于快速及缓慢性FA产前干预的临床研究,多局限于单中心、回顾性及小样本研究,不同研究的干预方案差异较大,临床证据级别较低。随着国内外FA产前干预工作的进一步发展,部分多中心、前瞻性随机对照临床试验研究数据的发布,在国内同道共同努力下,本意见内容将不断更新、完善,也将更符合国内临床实践需求,达到促进FA产前治疗及管理不断进步的目的。Fetal arrhythmias(FA)are common cardiac disorders in clinics of obstetrics and pediatric cardiology.Approximately 10%FA could persist or even progress,which may result in secondary organ injury,such as fetal heart failure,fetal premature delivery or even fetal demise.Based on accurate prenatal diagnosis of FA,reasonable classification and timely intervention for severely affected fetuses could improve prognosis of FA,which has great medical and sociological significance.Despite much progress have been achieved in field of prenatal management of FA in foreign countries,there are a few relevant studies in China.Moreover,there are great differences in prenatal management strategies for FA among different medical centers.In order to improve understanding of perinatal management of FA for obstetricians and pediatricians,standardize the intervention indications and treatment strategies,and promote the benign development of prenatal intervention for FA in China,experts from the Fetal and Perinatal Heart Disease Cooperation Team of Pediatric Cardiovascular Group of Chinese Pediatric Society,Chinese Medial Association put forward the Expert Guidance on Prenatal Treatment and Management for Fetal Arrhythmia after full discussion on prenatal intervention indications,treatment strategies as well as details of medicines selections according to the latest research progresses and current domestic situations.However,relevant clinical studies are limited to single-center,retrospective,and small sample size studies and the conclusions differed among different studies.Furthermore,only a minority of data were from China.Therefore,the evidences level are not so high.With further development of prenatal intervention for FA,the release of data from several multiple-centers,prospective and randomized controlled clinical studies,and with joint efforts of domestic clinicians,the content of this guidance will continue to be update and improved,and it will also be more in line with the actual domestic clinical practice needs,to achieve the

关 键 词：心律失常 心性 心率 胎儿 心动过速 室上性 心房扑动 房室传导阻滞 超声心动描记术 压力 产前诊断 水肿 胎儿 诊疗工作管理 医学 胎儿 

分 类 号：R71[医药卫生—妇产科学]