儿童先天性冠状动脉起源异常的临床预警信号和诊断策略  

Clinical early warning signs and diagnostic strategies for congenital anomalous origin of the coronary arteries in children

作　　者：梁欢 杨芳[2] Liang Huan;Yang Fang(Department of Pediatrics,Taining County General Hospital,Fujian Sanming 354400,China;Shengli Clinical Medical College of Fujian Medical University,Fujian Fuzhou 350001,China)

机构地区：[1]福建省三明市泰宁县总医院儿科,福建三明354400 [2]福建医科大学省立临床医学院,福建福州350001

出　　处：《创伤与急诊电子杂志》2024年第2期114-123,共10页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨儿童先天性冠状动脉异常起源(anomalousoriginofcoronaryartery,AOCA)的临床特征、诊断及处理,提高临床医师对该病的识别与诊治。方法本研究采用回顾性研究方法,搜集并分析了2013年1月至2022年12月期间在福建省立医院接受治疗的10例先天性冠状动脉异常起源儿童的临床资料,包括:一般资料、临床表现、实验室检查结果、心电图、心脏彩超及心脏CT血管成像等辅助检查结果。结果研究对象中共有10例患儿,男女比为6∶4,年龄1个月5天至13岁,其中左冠状动脉异常起源于肺动脉5例,右冠状动脉起源于左冠状窦2例,左冠状动脉起源于右冠状窦2例,左冠状动脉高开口1例。临床表现包括拒食、喂养困难、气促、心功能不全、心脏增大、心力衰竭、胸痛、活动后晕厥及心脏杂音等。心电图检查发现2例存在病理性Q波,8例显示ST-T改变。8例通过超声心动图诊断为AOCA,检出率为80%,所有患儿均通过心脏多层螺旋CT确诊。所有病例均行外科手术治疗,除1例死亡,其余疗效好。结论儿童AOCA少见,若临床上遇到婴儿左心扩大、心肌收缩功能减低,儿童运动后出现胸痛、晕厥,心电图提示有心肌缺血等这些早期预警信号,需考虑到该类疾病可能,进一步行超声心动图联合心脏多层螺旋CT检查,可提高诊断率,并及时进行手术治疗。Objective To explore the clinical characteristics diagnosis and management of anomalous origin of coronary artery(AOCA)in children and improve clinicians'ability to identify and treat this condition.Method We conducted a retrospective study to collect and analyze clinical data from 10 pediatric patients with congenital AOCA who were treated at Fujian Provincial Hospital from January 2013 to December 2022.Result A total of 10 pediatric patients were included in the study,with a male-to-female ratio of 6:4,and ages ranging from 1 month and 5 days to 13 years.Among them,5 cases had the anomalous left coronary artery originating from the pulmonary artery,two cases had the right coronary artery originating from the left coronary sinus,another two cases had the left coronary artery originating from the right coronary sinus,and one case had a high takeoff of the left coronary artery.Clinical manifestations included symptoms such as refusal of food,feeding difficulties,shortness of breath,cardiac insufficiency,cardiomegaly,heart failure,chest pain,syncope after exercise and cardiac murmurs.Electrocardiogram(ECG)revealed pathological Q waves in two cases and ST-T changes in eight cases..All the pediatric patients underwent confirmation of their diagnosis using multi-slice spiral computed tomography(MSCT)of the heart.Among the cohort,echocardiography successfully diagnosed eight out of ten patients(80%)with AOCA.All cases underwent surgical treatment with good outcomes in majority,except for one case that resulted in death.Conclusion AOCA in children is rare.If clinicians encounter early warning signals such as left heart enlargement,reduced myocardial contractile function in infants,and chest pain or syncope after exercise in children,along with ECG indications of myocardial ischemia,they should consider the possibility of AOCA.Further examination using echocardiography combined with cardiac multislice spiral CT can improve the diagnosis rate and facilitate timely surgical intervention.

关 键 词：冠状动脉异常起源 儿童 心电图 超声心动图 

分 类 号：R725.4[医药卫生—儿科]