新生儿心律失常致心功能不全的影响因素  

Influencing factors of cardiac insufficiency caused by neonatal arrhythmia

作　　者：李思晨 李晓惠[2] 李莉[1] 米荣[1] 王晓颖[1] 张利 Li Sichen;Li Xiaohui;Li Li;Mi Rong;Wang Xiaoying;Zhang Li(Neonatology Department,Children′s Hospital Capital Institute of Pediatrics,Beijing 100020,China;Cardiovascular Medicine Department,Children′s Hospital Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院新生儿内科,北京100020 [2]首都儿科研究所附属儿童医院心血管内科,北京100020

出　　处：《中国小儿急救医学》2022年第9期671-675,共5页Chinese Pediatric Emergency Medicine

基　　金：北京市医院管理局"登峰"人才培养计划(DFL20181301)。

摘　　要：目的探讨新生儿心律失常的临床特点及发生心功能不全的危险因素。方法选择2017年1月至2021年6月在首都儿科研究所附属儿童医院新生儿内科住院并诊断为新生儿心律失常患儿进行回顾性分析, 总结其临床特点, 分析心律失常导致心功能不全的危险因素。结果共纳入患儿90例, 男女比例1.43∶1(53∶37), 胎龄中位数39(37, 40)周;早产儿16例(17.8%), 足月儿74例(82.2%), 发病日龄中位数3(0, 11)d。本组患儿63.3%(57/90)为不规则节律型心律失常, 其中66.7%(38/57)为房性期前收缩;23.3%(21/90)为快速型心律失常;13.3%(12/90)为缓慢型心律失常。80.0%(72/90)患儿无典型临床表现。37.7%(34/90)患儿存在单一感染因素, 4.4%(4/90)存在感染合并围生期缺氧窒息。早产、孕母患自身免疫性疾病及快速型心律失常占比在心功能不全组明显高于心功能正常组[71.4%比13.3%, 28.6%比3.6%, 100%比16.9%, P均<0.05 ]。随机森林模型显示, 早产及孕母患自身免疫性疾病对于心功能的影响最大;对21例快速型心律失常分析显示, 心律失常的持续时间对心功能影响最大。结论新生儿心律失常以房性期前收缩最常见, 且无典型临床表现。感染及感染合并围生期窒息缺氧是新生儿心律失常的主要影响因素。早产、孕母患自身免疫性疾病及快速型心律失常的持续时间为新生儿心律失常导致心功能不全的主要危险因素。Objective To explore the clinical characteristics of neonate with arrhythmia and the potential risk factors for cardiac insufficiency.Methods Research data were collected from the cases of neonate with arrhythmia from January 2017 to June 2021 at the Neonatology Department at Children′s Hospital Capital Institute of Pediatrics.A retrospective analysis was conducted to summarize the clinical features and analyze the risk factors of arrhythmia leading to cardiac insufficiency.Results A total of 90 cases were enrolled,with a male to female ratio of 1.43∶1(53∶37),and the median gestational age was 39(37,40)weeks;with 16(17.8%)premature infants,74 full-term infants(82.2%),and the median onset age was 3(0,11)days.In this group,63.3%cases(57/90)were irregular rhythmic arrhythmias,of which 66.7%(38/57)were atrial premature contractions,23.3%(21/90)were tachyarrhythmias,and 13.3%(12/90)were bradyarrhythmias.Additionally,80.0%(72/90)of the cases had no typical clinical manifestations.Besides,37.7%(34/90)of the patients had single infection factor,and 4.4%(4/90)of the patients had infection with perinatal hypoxia asphyxia.The ratio of the premature birth,maternal autoimmune diseases and the tachyarrhythmia were higher in heart failure group than those in normal heart function group(71.4%vs.13.3%,P<0.001;28.6%vs.3.6%,P=0.006;100%vs.16.9%,P<0.001).The random forest model showed that the factors of premature delivery and maternal autoimmune disease had the greatest influence on cardiac function,and the analysis of 21 tachyarrhythmias showed that the duration of arrhythmia had the greatest influence on cardiac function.Conclusion Atrial premature contraction is the most common in neonate with arrhythmia,and with non-typical clinical manifestations.The infection and the infection combined with perinatal asphyxia are the main influencing factors of neonate with arrhythmia.Premature delivery,maternal autoimmune disease and the duration of tachyarrhythmias are the main risk factors of neonatal arrhythmias leading to cardiac d

关 键 词：心律失常 新生儿 临床特点 心功能不全 

分 类 号：R722.1[医药卫生—儿科]