临床儿科杂志 ›› 2016, Vol. 34 ›› Issue (4): 258-.doi: 10.3969 j.issn.1000-3606.2016.04.005

• 综合报道 • 上一篇    下一篇

儿童快速型心律失常107 例临床诊治分析

徐萌, 肖婷婷, 沈捷, 黄敏, 谢利剑, 王健怡   

  1. 上海市儿童医院 上海交通大学附属儿童医院心内科(上海 200062)
  • 收稿日期:2016-04-15 出版日期:2016-04-15 发布日期:2016-04-15
  • 通讯作者: 肖婷婷 E-mail:xjtt2000@smmail.cn

Clinical diagnosis and treatment of tachyarrhythmia in 107 pediatric patients

XU Meng, XIAO Tingting, SHEN Jie, HUANG Min, XIE Lijian, WANG Jianyi   

  1. Department of Cardiology, Shanghai Children’s Hospital, Children’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200062, China
  • Received:2016-04-15 Online:2016-04-15 Published:2016-04-15

摘要: 目的 探讨儿童快速型心律失常的临床诊断、治疗及预后。方法 回顾性分析2011 年1 月至2014 年12 月收治的107 例快速型心律失常患儿的临床资料,按住院24 h 动态心电图中室上性快速型心律失常占总心率50%以上或室性心动过速占10%以上分为无休止性组和间歇性发作组,比较两组患儿的临床特征。结果 107例患儿中,男64例、女43例。31 例无休止性组中位年龄7 个月,包括阵发性室上性心动过速(PSVT)13 例、房性心动过速(AT)13 例、紊乱性房性心动过速(CAT)2 例、房颤1 例、交界性异位性心动过速(JET)1 例和室性心动过速(VT)1 例,发展为心动过速性心肌病21 例 (67.7%);76 例间歇性发作组中位年龄6 岁,包括PSVT 55 例、AT 4 例、CAT 2 例、房扑5 例(合并房颤2 例)、房颤1 例、JET3 例和VT 6 例。无休止性组单药治疗14 例,联合用药17 例;间歇性发作组单药治疗61 例,联合用药11 例。两组患儿中药物不能有效控制者选择食管心房调搏术治疗17 例、电击复律3 例、心脏临时起搏2 例及射频消融术30 例。随访6 个月,无休止性组2 例PSVT复发,2 例AT、1 例房颤和1 例JET 控制室率;间歇性发作组7 例PSVT、1 例VT复发,1 例房扑控制室率,PSVT、VT各放弃治疗和死亡2 例,余病例均持续恢复窦性心律。两组患儿的年龄、PSVT与其他快速型心律失常例数、血清cTnI ≥ 0.30 ng/mL 例数、血清NT-proBNP ≥ 250 pg/mL 例数,以及单药和联合用药治疗例数的差异均有统计学意义(P < 0.05)。结论 无休止性快速型心律失常治疗难度大,常需联合用药,易发展为心动过速性心肌病。

Abstract: Objective To discuss the diagnosis, treatment, and outcomes of pediatric tachyarrhythmia. Methods Clinical data of 107 pediatric inpatients with tachyarrhythmia from January 2011 to December 2014 were retrospectively analyzed. According to 24 hours holter, all patients were divided into two groups, incessant group whose supraventricular tachyrhythmia were more than 50% of heart rate, and intermittent group whose ventricular tachycardia were more than 10%. The clinical features were compared between two groups. Results In a total of 107 patients (64 male and 43 female), there were 31 cases in incessant group with the median age of 7 months which included 13 cases of paroxysmal supraventricular tachycardia (PSVT), 13 cases of atrial tachycardia (AT), 2 cases of chaotic atrial tachycardia (CAT), 1 case of atrial fibrillation (Af), 1 case of junctional ectopic tachycardia (JET), and 1 case of ventricular tachycardia (VT). Among them, 21 cases (67.7%) were progressed to tachycardiainduced cardiomyopathy. There were 76 cases in intermittent group with the median age of 6 years which included 55 cases of PSVT, 4 case of AT, 2 cases of CAT, 5 cases of atrial flutter (AF) (2 cases combined with Af), one case of Af, 3 cases of JET, and 6 cases of VT. 14 cases received monotherapy and 17 cases received combination drug therapy in incessant group. Meanwhile, 61 cases received monotherapy and 11 cases received combination drug therapy in intermittent group. In two groups, because the symptoms of tachyarrhythmias could not be controlled effectively, 17 cases had to treat by transesophageal atrial pacing, 3 cases treated by electrical cardioversion, 2 cases treated by cardiac temporary pacing, and 30 cases treated by radiofrequency ablation. In 6 months of follow-up, one case of VT relapsed, 2 cases of AF and one case of JET controlled ventricular rate in incessant group, while 7 cases of PSVT and one cases of VT relapsed, one cases of AF controlled ventricular rate, and 2 cases of PSVT and VT abandoned therapy and died respectively in intermittent group. The sinus rhythms were recovered in remaining cases. There were statistical differences in age, proportion of PSVT and other rapid arrhythmia, proportion of serum level of cTnI ≥ 0.30 ng/ml, proportion of serum level of NT-proBNP≥ 250 pg/ml, and proportion of monotherapy or combination drug therapy between two groups (P < 0.05). Conclusions It was difficult to treat intermittent rapid arrhythmia, which required combination drug therapy and was prone to develop into tachycardia-induced cardiomyopathy.