儿童恶性心律失常70例临床分析

目的 探讨儿童不同恶性心律失常的构成比、伴发疾病、药物治疗效果。 方法 回顾性分析2012年1月-2016年12月安徽省立医院儿科诊断的70例恶性心律失常儿童的临床资料。依据不同恶性心律失常及不同伴发疾病统一的诊断标准,分析不同心律失常构成比及伴发疾病。分析不同恶性心律失常年龄分布特征。按照治疗结局,将其分为难治性心律失常组与非难治性心律失常组,运用确切概率法分析不同种类心律失常发生难治性心律失常的概率。 结果 70例恶性心律失常患儿中,男45例,女25例,心房扑动5例,房性心动过速12例,房颤合并房性心动过速1例,Ⅱ度Ⅱ型房室传导阻滞及Ⅲ度房室传导阻滞12例,室上性心动过速40例。不同心律失常各年龄段均有分布,房间隔膨出瘤全部见于新生儿。不同心律失常伴发疾病不相同:室上性心动过速发作多与呼吸道感染相关,房性心动过速多合并心脏明显扩大,心房扑动部分合并房间隔膨出瘤,Ⅱ度Ⅱ型房室传导阻滞及Ⅲ度房室传导阻滞多与心肌炎发生相关。室上性心动过速发生难治性心律失常的概率明显小于房性心动过速及传导阻滞(P<0.01)。心房扑动发生难治性心律失常概率与房性心动过速及传导阻滞组差异无统计学意义(P=0.10)。 结论 不同种类恶性心律失常构成比、伴发疾病不同,室上性心动过速药物治疗效果明显优于房性心动过速及房室传导阻滞。 

Clinical analysis of 70 children with malignant arrhythmias

Objective To discuss constituent ratio,concomitant disease and medication effects of malignant arrhythmias (MA) in children. Methods The clinical data of 70 children with MA diagnosed in our hospital from January,2012 to January,2016 were retrospectively analyzed.The constituent ratio of different types of arrhythmias and concomitant disease were described according to the diagnostic criteria of MA and concomitant diseases.The age distribution characteristics of different types of MA were investigated.According to the treatment outcome,the children were assigned into refractory arrhythmia group and non-refractory arrhythmia group.Fisher exact probability test was performed to analyze the distribution of different arrhythmias between the two groups. Results Among 70 children,there were 45 cases of male and 25 cases of female;there were 5 cases of atrial flutter,12 cases of atrial tachycardia,12 cases of atrioventricular heart-block,40 cases of supraventricular tachycardia,and 1 case of atrial tachycardia with auricular fibrillation.There were different types of arrhythmias at different ages.The atrial septal aneurysm was all found in neonates.Different types of arrhythmia were with different concomitant diseases:supraventricular tachycardia was associated with respiratory infection,atrial tachycardia was combined with cardiac enlargement,atrial flutter was combined with atrial septal aneurysm,supraventricular tachycardia was associated with respiratory infection,atrioventricular block was associated with myocarditis.The probability of refractory arrhythmia in supraventricular tachycardia was significantly lower than that of atrial tachycardia and atrioventricular heart-block (P<0.01).There was no difference in the incidence of refractory arrhythmia between atrial flutter and atrial tachycardia or heart-block (P=0.10). Conclusion The clinical characteristics and medication effects were different among different MA in children.The therapeutic effect of supraventricular tachycardia was superior to atrial tachycardia and atrioventricular block.