胎儿超声心动图检测胎儿心律失常的研究

目的 探讨应用胎儿超声心动图检测胎儿心律失常的价值及临床意义.方法 对306例孕龄20～39周的临床上疑有胎儿心律失常或存在其它异常的胎儿进行采用彩色多普勒超声心动图检查.结果 在306例研究对象中检测出心律失常者为62例.期前收缩39例,包括房性期前收缩31例,室性期前收缩8例;心动过速15例,包括窦性心动过速10例,室上性心动过速5例;心动过缓8例,包括窦性心动过缓5例,房室传导阻滞3例.62例心律失常胎儿中发现先天性心血管畸形5例.结论 胎儿超声心动图用于诊断胎儿心律失常快速可靠,又可提供胎儿心脏结构及血流动力学信息.     

不同类型胎儿心律失常的围产期处理及结局

目的探讨不同类型胎儿心律失常的围产期处理及结局。方法回顾性分析2003年10月~2010年12月在深圳市妇幼保健院经超声心动图筛查诊断为胎儿心律失常的病例。结果共筛查胎儿心律失常130例,其中期前收缩59例、窦性心动过缓23例、窦性心动过速16例、房室传导阻滞12例、房颤3例、其他心律失常17例。其中12例(9.2%)合并先天性心血管畸形,胎儿心动过缓多见。心律失常不同分类之间的预后有显著性差异(P=0.000)。心律失常分类(P=0.024)、合并先天性心脏病(P=0.000)及胎儿水肿(P=0.008)是胎儿预后不良的危险因素。结论大部分阵发性心律失常胎儿在严密监护保守治疗下,胎儿预后良好,胎儿心动过缓预后较差。胎儿心律失常围生期预后与胎儿心律失常分类、是否伴有心血管或其他畸形、有无胎儿水肿密切相关。     

彩色多普勒超声心动图在胎儿心律失常中临床应用探讨

目的探讨超声检测在胎儿心律失常方面的诊断价值及临床意义。方法对临床疑有胎儿心律失常或伴其他异常妊娠史的200例胎儿进行超声心动图检查。结果经超声检测显示25例（12．5％）胎儿出现心律失常现象,其中心动过速10例（包括5例窦性心动过速及5例室上性心动过速）,心动过缓5例,房性早搏5例。室性早搏2例,房扑1例,合并先天性心脏病2例（其中心内膜垫1例,室缺1例）。结论彩色多普勒超声心动图能够早期诊断胎儿心律失常的类型及胎儿心脏结构功能状况,能为是否需要终止妊娠提供参考临床依据：胎儿心律失常多为功能性及暂时性的,超声检测在胎儿心律失常的正确诊断及在临床合理的干预中具有重要的指导意义。     

超声心动图对胎儿心律失常诊断的意义

目的探讨超声心动图检查对胎儿心律失常诊断的意义。方法选取2014年1月至2015年9月在我院进行产前检查有胎儿心律失常的56例孕妇,行胎儿超声心动图检查,对胎儿心律失常进行分型,并利用超声随访,综合评估其转归及预后。结果 56例心律失常胎儿中,心动过速胎儿34例(16例胎儿表现为室上性心动过速,18例胎儿表现为窦性心动过速),房性早搏胎儿6例,心动过缓胎儿5例,室性早搏胎儿7例,房扑胎儿2例,2例因胎儿心脏结构重度畸形引产。结论超声心动图检查对产前诊断胎儿心律失常具有重要的意义。该方法操作简单、结果直观、无创,并且对于心律失常胎儿的临床诊断具有较高的特异性和准确性,值得临床推广。     

胎儿心律不齐的超声心动图诊断及临床转归

目的应用胎儿超声心动图诊断胎儿心律不齐并对其临床转归进行跟踪评价。方法对208例孕龄20-28周的临床疑有胎儿心律失常或存在其他异常的胎儿进行超声心动图检查,对检出的26例胎儿心律不齐者于妊娠37-40周及出生后1周内再次进行随访观察。结果检出胎儿心律不齐26例,其中房性期前收缩21例,室性期前收缩5例。其中1例于孕35周早产,早产儿产后心电图检查无异常。7例于妊娠37-40周复查时心律不齐消失。产后1周内新生儿心电图检查均无异常。26例胎儿超声心动图检查均无心血管畸形。结论胎儿心律不齐多于出生前后消失,不伴有心血管畸形,不需要特殊治疗。     

538例青年女性健康体检心电图分析

[目的]了解22～31岁年龄段青年女性的心电图异常发生情况。[方法]采用日本光电9320K12导联心电图机同步描记,以郭继鸿主编的2002年版的《心电图学》为标准,分析538例青年女性健康体检的心电图结果。[结果]心电图异常者74例(13.8%)。其中,窦性心动过缓23例(31.1%),窦性心律不齐19例(25.7%),窦性心动过速15例(20.3%)。ST-T改变13例(17.6%)。室性期前收缩5例(6.8%),房性期前收缩2例(2.7%)。[结论]青年女性异常心电图以窦性心动过缓、窦性心律不齐、窦性心动过速、ST-T改变及期前收缩为常见。     

新生儿心律失常30例临床分析

目的探讨新生儿心律失常的特点、病因、类型、临床表现及防治。方法采用心电监护、体表心电图检查出心律失常30例。进一步作心肌酶测定、心脏彩超、胸片明确心律失常之病因和类型。结果窦性心动过缓12例,占40％;期前收缩6例,占20％;传导阻滞5例,占16．7％;其他占23．3％。治愈19例,好转8例,自动出院2例,死亡1例。结论新生儿心律失常常无明显征候,多为常规体检或心电监护时发现。原因与缺氧、感染引起的代谢紊乱、先天性心脏结构异常、药物因素和其他不明因素有关。新生儿心律失常多数无需特殊治疗,在治疗原发病基础上大多预后良好。     

胎儿期心律失常的诊断及其临床意义探讨

目的：探讨胎儿期心律失常的诊断方法、临床意义及对新生儿预后的影响。方法收集产前检查中发现胎儿心律失常的57例孕妇资料,分析孕妇病史、胎儿心电图、胎儿超声心动图、妊娠结局等。结果胎儿心律失常中胎儿心动过速、胎儿心动过缓和不规则胎儿心律的发生率分别为7.0%、3.5%和89.5%。经期待疗法,孕期胎儿心律恢复正常的有21例（36.8%）,出生后新生儿心律迅速恢复正常的有15例（26.3%）,产后7d新生儿心律恢复正常的有14例（24.6%）。4例胎儿（7.0%）发现心脏结构异常。结论大部分胎儿心律失常与胎儿的心脏调节功能尚未完善有关,约91.2%在分娩前或出生后心律恢复正常;胎儿期心律失常预后不良相关的因素为胎儿水肿、持续性心律失常。     

新生儿心律失常发病的影响因素及治疗

目的 探讨新生儿心律失常发病的影响因素及治疗。方法 对51例新生儿心律失常临床资料进行回顾性分析。结果 有1项或多项围产高危因素共41例（80．39％），官内窘迫、娩出窒息、早产与心律失常发生有关，宫内窘迫和娩出窒息多引起室性心律失常、房室传导阻滞和窦性心动过缓，较少引起室上性心律失常。胎儿期出现的心律失常伴随心血管异常，以先天性心脏病最多见（26．67％），其次为胎儿心肌炎，生后出现的心律失常以缺氧心肌损害为主（44．44％），其次为电解质紊乱。房扑、室上性及室性心动过速对心律平疗效好，与缺氧、低钙血症有关的房室传导阻滞对静脉注射葡萄糖酸钙疗效好，早搏多不需治疗，与缺氧有关的早搏消失快。结论 新生儿心律失常发病与围产高危因素关系较大，主要是缺氧心肌损害，其次为先天性心脏病、胎儿心肌炎及电解质紊乱。产前胎儿心电监护和胎儿心电图检查对早期诊断有重要价值。心律平对多种心律失常有效，可作为首选药物。     

围产期监护和新生儿

以犯朋1胎儿心律失常的超声心动图诊断/唐红伟…//中国超声医学杂志一2以刃,16(l)一41-43 应用超声心动图诊断胎儿心律失常。对年龄20一30岁,妊娠20一扣周孕妇、临床疑有胎儿心律失常或有的伴有其他异常妊娠史的214例胎儿进行超声心动图检查。结果:在可疑的214例胎儿中超声诊断36例胎儿心律失常。其中房性早搏17例,室性早搏6例,室上性心动过速8例,心动过缓3例,完全性房室传导阻滞2例。同时发现4例 157.胎儿心脏结构崎形。作者认为超声心动图既可以判断胎儿心律失常的性质,又可以诊断胎儿心脏结构崎形。表1(冯碧玉)以心阴2乙破蛆旋.素治疗孕…     

家用心电监护仪在心律失常病人中的应用

目的探讨家用便携式心电监护仪在心律失常病人中的临床应用价值。方法与青岛海信集团医疗电子研究所共同研制一款家用便携式心电监护仪及心电数据分析软件,应用于300例心血管疾病高危人群,记录其心电数据资料,通过门诊就诊或者网络上传方式汇总分析。结果在300例病人中共检查出心律失常280例（94.92%）,包括窦性心动过缓32例（10.85%）,窦性停搏5例（1.69%）,房性期前收缩51例（17.29%）,短阵房性心动过速28例（9.49%）,阵发性心房颤动12例（4.07%）,室性期前收缩132例（44.75%）,短阵室性心动过速5例（1.69%）,房室传导阻滞7例（2.37%）,持续性心房颤动伴RR长间期〉3s者8例（2.71%）;检出ST-T改变者72例（24.41%）,其中经冠状动脉造影证实冠状动脉狭窄31例（10.51%）,行支架植入术13例（4.41%）;未见异常15例（5.08%）。结论家用便携式心电监护仪是一种有效的心血管疾病的筛查仪器,有很好的临床应用价值。     

Identification of congenital cardiac malformation and in utero arrhythmia by fetal echocardiography

M-mode, 2D and Pulsed Doppler Echocardiography were performed on 111 fetuses of high-risk pregnancies. Fetal gestation ages ranged 16-41 weeks. Six congenital cardiac diseases were detected in utero and confirmed at autopsy in 4 cases, and one by Pulsed Doppler Echocardiography after delivery. These included a rhabdomyoma, an endocardial fibroelastosis with hydrops, a pulmonary stenosis with tricuspid regurgitation, a VSD, a VSD with descending aortic stenosis, an AV canal defect with single atrium and single AV valve with regurgitation. Arrhythmia was diagnosed in 23 fetuses, 9 had transient sinus bradycardia, 8 had premature atrial contraction, 2 had premature ventricular contraction which disappeared after birth, 4 had sustained sinus bradycardia, one of them combined PVC occurring in bigeminy and trigeminy, which continued after birth. These 4 fetuses had congenital heart disease. Conclusion: (1) 2 DE and PDE are the most valuable non-invasive technique for detection of fetal structural cardiac abnormalities. (2) M-mode and PDE make correct rhythm diagnosis in fetus. (3) The fetus with transient sinus bradycardia or PAC usually has a favorable prognosis. Sustained bradycardia has a more ominous prognosis, particularly if associated with heart abnormalities. (4) Fetal hydrops may associate with congestive cardiac failure in uterus. The incidence of cardiac disease is high in hydrops.     

Fetal arrhythmias; intrauterine diagnosis and treatment.

Fetal echocardiographic examination was performed on 945 pregnant women (normal pregnancy: 291, high risk pregnancy: 654) since 1980. Of these, 39 fetuses (4.1%) were diagnosed as having cardiac arrhythmia. Fifteen fetuses had bradycardia, 7 tachycardia and 17 had an ectopic beat. These had been followed from 1 day to 8 years (mean 1 year and 6 months) soon after birth. Of the 15 cases with bradycardia (complete AV block; 8, 2:1 AV block; 3 and sinus bradycardia; 4), four resulted in an intrauterine fetal death, one was terminated and 5 died soon after birth. The remaining 5 cases are alive and 3 of these 5 have received an implanted pacemaker. Of these 15 cases with bradycardia 7 were associated with congenital heart disease, 6 of which died. Seven cases had tachycardia (supraventricular tachycardia: 3 and atrial flutter with 2:1 AV block: 3). Transplacental antiarrhythmic drug (digoxin and/or verapamil) administration was instituted in 5 cases and a conversion of the arrhythmia was achieved in 4. Paroxysmal tachycardia still remained after delivery in the other 3 cases. Two cases with supraventricular tachycardia (one of them with WPW syndrome type B) were resolved. One case has had persistent chaotic atrial rhythm for 7 years after birth. Of the 17 with an ectopic beat, 11 cases were diagnosed to have a supraventricular ectopic beat and 6 cases with a ventricular ectopic beat. A remaining arrhythmia was observed in 10 cases after delivery but all of these were resolved within 3 months after birth. Fetal tachycardia had relatively favorable prognosis because usually the intrauterine treatment was effective. However, fetal bradycardia had poor prognosis and further investigations to establish more effective treatments are essential.     

Prenatal diagnosis of persistent fetal bradycardia: report of four cases

Persistent fetal bradycardia is infrequent in prenatal life and difficult to manage optimally. It is generally attributable to sinus bradycardia due to fetal distress, blocked atrial extrasystoles, and congenital complete heart block. We reported four cases of persistent fetal bradycardia from 1995 to 1999 in our hospital. The first, second, and third cases of sustained fetal bradycardia had congenital complete heart block with positive titers for anti-Ro/SSA antibodies in both mothers and fetuses. Because of progressive fetal hydrops in the second case, the pregnancy was terminated. The first and third cases were isolated congenital complete heart block without structural anomaly. After prenatal examination the babies were followed up closely until term and both had a good prognosis without any implantation of pacemaker. In the fourth case there was no clinically known etiology associated with sustained fetal bradycardia. The fetal heart rate returned to normal after 6 weeks of follow-up and the baby was delivered without any cardiac problems. Congenital complete heart block is the most common cause of persistent fetal bradycardia. Prenatal detailed monitoring until delivery is necessary before heart failure develops. Treatment strategies (corticosteroids, ritodrine, and plasmapheresis) are debatable and may include prophylactic therapy for high-risk pregnant women.     

急性心肌梗死早期溶栓后再灌注心律失常及预后分析

目的：探讨急性心肌梗死早期溶栓后再灌注心律失常对预后的影响。方法：对确诊为急性心肌梗死的30例患者临床诊治资料进行回顾性分析。结果：30例患者中,冠状动脉再通25例,再通率83.33%;未通5例。再通病例中均出现再灌注心律失常,包括室上性心动过速6例,室性早博7例,短阵室速4例,室颤2例。高度房室传导阻滞3例,窦性心动过缓6例,死亡6例均为窦性心动过缓或高度房室传导阻滞。结论：早期溶栓仍然是抢救急性心肌梗死的首选措施,急性心肌梗死再灌注后缓慢心律失常死亡率明显高于快速心律失常（P〈0.05）。     

妊娠合并心脏病45例临床分析

目的：探讨妊娠合并心脏病对母儿预后的影响。方法：对我院2002年1月～2007年12月间45例妊娠合并心脏病患者的临床资料进行回顾性分析。结果：①妊娠合并心脏病患者以心律失常的发生率最高（13例,28.89%）,其次为先天性心脏病（12例,26.67%）。②妊娠合并心脏病孕产妇病死率为4.44%（2/45）,死亡专率为27.81/10万（2/7190）。③心功能Ⅳ级患者与心功能Ⅰ级、Ⅱ级、Ⅲ级患者比较,围生儿死亡率明显增加（P〈0.01）。④分娩方式：经阴道自然分娩8例,占18.18%;阴道手术助产2例,占4.55%;剖宫产34例,占77.27%。结论：45例妊娠合并心脏病患者中,心律失常的发生率最高,心功能Ⅳ级患者围生儿死亡率明显增加,分娩方式的选择以剖宫产为主。     

CLINICAL SIGNIFICANCE AND PROGNOSIS OF FETAL ARRHYTHMIAS

Objective To explore fetal arrhythmia clinical significance and its correlation with fetal prognosis. Methods Twenty-six cases of fetal arrhythmia detected among 12 799 pregnant women recorded over a ten-year period in Peking Uinon Medical College (PUMC) Hospital were reviewed retrospectively. Fetal arrhythmia was diagnosed by fetal auscultation, ultrasonography, electric fetal heart monitoring, and fetal echocardiography. Twenty-six fetuses were documented with fetal arrhythmia (3 tachycardia, 4 bradycardia, 19 normal heart rate with irregular fetal cardiac rhythm). The incidence of fetal arrhythmia in our hospital was 0.2%. They were diagnosed at the average of 35 weeks‘ gestation (15 to 41 weeks). Twenty-two cases were diagnosed by antenatal fetal auscultation, l case was diagnosed by ultrasonography, and 3 cases were diagnosed by electric fetal heart monitoring. Fetal echocardiograms were performed on 17 fetuses, 6 cases (35.3%) of which showed that ventricular premature beats with normal structure of fetal heart.All neonates survived postnatally and 24 of them (92.3%) were followed up. Echocardiograms were performed for 16 neonates and 2 of them were identified as atrial septal defects with normal heart rhythms. The results of follow-up showed that the two patients had no apparent clinical manifestation. The echocardiogram showed that atrial septal defect obliterated already. Conchusion The prognosis is well for most of the fetuses with arrhythrnias, with low incidence of heart deformation.     

超声心动图在胎儿先心病诊断中的应用价值探讨

目的：探讨超声心动图在胎儿先心病诊断中的应用价值。方法：选取有高危因素的孕妇430例作为观察组,无明显高危妊娠因素的孕妇560例,作为对照组。所有孕妇均采用日立HITACHI型彩色多普勒超声诊断仪进行胎儿超声心动图检查,并对比产前与分娩后或胎儿尸检结果。结果：检查发现共42例存在先心病,检出率为4．2％。其中观察组检出39例（9．1％）,对照组检出3例（0．5％）,观察组先心病检出率明显高于对照组（P＜0．05）,差异具有统计学意义。结论：超声心动图能及时有效发现胎儿心脏异常的情况,诊断过程简单、时间较短,并且可以重复检查,对检测胎儿心脏畸形有着十分重要的临床应用价值。