胎儿快速性心律失常的心电图特点及临床分析  

Electrocardiogram characteristics and clinical analysis of fetal tachyarrhythmia

作　　者：魏欣 余婷婷 闻捷 周奕菲 郑菲 李花莲[1] WEI Xin;YU Ting-ting;WEN Jie;ZHOU Yi-fei;ZHENG Fei;LI Hua-lian(Department of Electrocardiogram and Electroencephalogram,Maternal and Child Health Hospital of Hubei Province.Wuhan 430072,Hubei,China)

机构地区：[1]湖北省妇幼保健院心脑电图诊断科,湖北武汉430072

出　　处：《中国心脏起搏与心电生理杂志》2023年第2期116-121,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的分析不同类型胎儿快速性心律失常的胎儿心电图(FECG)表现及其临床特征,并追踪妊娠结局。方法回顾性分析近5年本院检诊的胎儿快速性心律失常病例,根据胎儿心电图表现结合出生后新生儿体表心电图结果,将病例分为窦性心动过速(简称窦速)、房性心动过速(简称房速)、室上性心动过速(简称室上速)和心房扑动(简称房扑),随访母-胎状况、妊娠结局及新生儿治疗和转归情况。结果胎儿室上性快速性心律失常病例共23例,其中室上速13例(56.5%),房扑5例(21.7%),窦速3例(13.0%),房速2例(8.7%)。室上速初诊时其母孕周明显小于房扑胎儿孕母的[(32.47±4.42)周vs(35.89±1.11)周,P<0.05],房扑胎儿持续性心律失常、胎心结构异常(室间隔缺损、三尖瓣中度返流)、及胎儿水肿的发生率均较室上速胎儿高(分别为60.0%vs30.8%;40.0%vs7.7%;40.0%vs23.1%,P均<0.05),所有病例产前未予以药物干预,持续快速性心率致胎儿水肿者予以剖宫娩出,其余密切监测至胎儿娩出,窦速胎儿心律多可在妊娠期自行恢复,室上速、房扑、房速胎儿在出生后经治疗后全部复律,随访6个月发现有2例室上速合并多源性房速者复发。结论室上速是最常见的快速性心律失常,最早可在孕中期发现。对于孕周较小的胎儿快速性心律失常,若血流动力学稳定,期待治疗可获得良好结局,产后抗心律失常药物治疗效果显著。Objective To analyze the clinical features and fetal electrocardiogram(FECG)manifestations of different types of fetal tachyarrhythmia,and to track the pregnancy outcome.Methods The cases of fetal tachyarrhythmia in our hospital in the past five years were analyzed retrospectively.According to the FECG and the postnatal body surface electrocardiogram,the cases were divided into four types:sinus tachycardia,supraventricular tachycardia,atrial flutter and atrial tachycardia.The maternal fetal status,pregnancy outcome,neonatal treatment and outcome were followed up.Results There were 23 cases of fetal supraventricular tachyarrhythmia,including 13 cases of supraventricular tachycardia(56.5%),5 cases of atrial flutter(21.7%),3 cases of sinus tachycardia(13.0%),and 2 cases of atrial tachycardia(8.7%).The average gestational age in the fetuses with the supraventricular tachycardia was significantly less than that in with the atrial flutter[(32.47±4.42)W vs(35.89±1.11)W,P<0.05],while the incidence of persistent arrhythmia,fetal cardiac structural abnormalities(ventricular septal defect,moderate tricuspid regurgitation),and fetal edema was higher than that in fetuses with supraventricular tachycardia(60.0%vs 30.8%;40.0%vs 7.7%and 40.0%vs 23.1%,respectively).No drug intervention was given to all cases before delivery.Those with fetal edema caused by sustained tachycardia were delivered by cesarean section.The rest were closely monitored until the fetus was delivered.The fetal rhythm in the fetuses with sinus tachycardia recovered spontaneously during pregnancy.After birth,all the neonates in other three types tachycardia could recovered after treatment.The follow-up period was 6 month,2 cases of supraventricular tachycardia recurred.C.onclusion Supraventricular tachycardia is the most common tachyarrhythmia,it can be found in the second trimester at the earliest.For fetal tachyarrhythmia with small gestational age,if the hemodynamics is stable,the treatment is expected to achieve a good outcome,and the effect of postpart

关 键 词：心血管病学 胎儿心电图 窦性心动过速 室上性心动过速 心房扑动 房性心动过速 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]