摘要
目的探讨新生儿心律失常的临床特征、病因、诊治及疗效。方法对2013年5月至2018年5月我院新生儿科收治的心律失常患儿临床资料进行回顾性分析,全部病例按照临床严重程度分为良性心律失常组和非良性心律失常组,总结并比较两组患儿的临床特征、病因、诊治及疗效。结果共纳入新生儿心律失常患儿128例,其中男89例,女39例;足月儿106例,早产儿22例;房性期前收缩39例(30.5%),房性心动过速5例(3.9%),心房扑动10例(7.8%),阵发性室上性心动过速36例(28.1%),室性期前收缩26例(20.3%),房室传导阻滞12例(9.4%);良性心律失常65例(50.8%),非良性心律失常63例(49.2%)。52例(40.6%)出现心外表现(其中气促10例,面色青紫或苍白9例,拒奶5例,呻吟3例,25例合并2种或2种以上临床症状),余76例(59.4%)症状不典型或无临床症状;31例(24.2%)有心功能不全。新生儿心律失常的前3位病因依次为感染32例(25.0%)、围生期窒息缺氧20例(15.6%)和先天性心脏病19例(14.8%)。87例(68.0%)患儿以治疗原发病为主,辅以营养心肌药物,均痊愈;41例(32.0%)患儿根据心律失常类型及心功能情况予以抗心律失常药物治疗或电复律,20例痊愈,18例好转,3例未愈。非良性心律失常组男婴、有心外表现、心功能不全比例、肌钙蛋白I和磷酸肌酸激酶同工酶水平高于良性心律失常组,发病日龄大于良性心律失常组,住院天数长于良性心律失常组,差异有统计学意义(P<0.05)。结论感染、围生期窒息缺氧、先天性心脏病是新生儿心律失常的高危因素,新生儿出现气促、面色青紫、苍白或拒奶等症状时应注意评估是否有心律失常,并鉴别良性与非良性心律失常。
Objective To discuss the clinical features, pathogenesis, diagnosis, treatment and therapeutic outcome of neonatal cardiac arrhythmia. Method The clinical data of newborns with arrhythmia admitted from May 2013 to May 2018 were analyzed retrospectively. All cases were grouped into benign and non-benign arrhythmia groups according to the severity of clinical manifestations. The clinical features, pathogenesis, diagnosis, treatment and therapeutic outcome of them were compared. Result There were 128 cases including 89 (69.5%) males, 39 (30.5%) females; 106 (82.8%) full-term infants, 22 (17.2%) premature infants; 39 (30.5%) atrial premature contraction, 5(3.9%) atrial tachycardia, 10(7.8%) atrial flutter, 36(28.1%) paroxysmal supraventricular tachycardia, 26 (20.3%) ventricular premature contraction, 12(9.4%) atrioventricular block; 65 cases (50.8%) were benign arrhythmia and 63 cases (49.2%) were non-benign. 52 cases (40.6%) showed noncardiac symptoms (including 10 cases of shortness of breath, 9 cases of pallor or cyanosis, 5 cases of refusal to suck, 3 cases of grunting, 25 cases with two or more than two kinds of clinical symptoms), and 76 cases (59.4%) were asymptomatic; 31 cases (24.2%) were cardiac insufficiency. The three common causes of neonatal cardiac arrhythmia were: 32 (25%) cases by infection, 20 (15.6%) cases by perinatal asphyxia, 19 (14.8%) cases were congenital heart disease; 87 (68.0%) cases were mainly treated with primary diseases. 41 cases (32.0%) were treated with antiarrhythmic drugs or cardioversion. There was significant difference in gender, noncardiac symptoms, cardiac insufficiency, age of onset, days of hospitalization, cardiac troponin I and creatine kinase isoenzyme between the two groups (P<0.05). Conclusion Neonatal cardiac arrhythmias should be considered and evaluated with shortness of breath, cyanosis or pallor and rejection refusal of milk. High risk factors of neonatal cardiac arrhythmias included infection, perinatal asphyxia and congenital heart disease. Benign and non-benign arrhythmia should be identified.
作者
盛王涛
孙建华
贝斐
李菁
Sheng Wangtao;Sun Jianhua;Bei Fei;Li Jing(Department of Neonatology, Shanghai Children′s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China)
关键词
心律失常
心性
感染
窒息
先天性心脏病
临床特点
Arrhythmia, cardiac
Infection
Asphyxia
Congenital heart disease
Clinical features
