摘要
目的比较婴儿先天性心脏病术后早期并发室上性心动过速采用经食管心房调搏和静脉泵注胺碘酮2种方法转复窦性心律的效果。方法先天性心脏病术后早期并发室上性心动过速婴儿82例,48例采用静脉泵注胺碘酮治疗者为对照组,34例采用经食管心房调搏治疗者为观察组。比较2组转复窦性心律比率、转复窦性心律所需时间、不良反应发生率;比较2组干预前(心律失常发作时)、干预后(转复窦性心律或治疗结束)心率、有创动脉收缩压和左室射血分数。结果观察组转复窦性心律比率(47.06%)、不良反应发生率(20.59%)与对照组(52.08%、6.25%)比较差异均无统计学意义(P>0.05),转复窦性心律所需时间[(10.63±3.86)min]较对照组[(26.20±11.25)min]短(P<0.05)。对转复窦性心律患儿,观察组、对照组干预后心率[(146.69±16.64)、(139.48±15.50)次/min]较干预前[(222.81±12.89)、(222.24±8.80)次/min]减慢(P<0.05)、收缩压[(84.06±10.90)、(81.20±9.11)mm Hg]、左室射血分数[(61.94±6.09)%、(61.72±11.37)%]较干预前[收缩压:(62.50±4.77)、(62.60±6.19)mm Hg;左室射血分数:(59.94±6.36)%、(60.20±12.27)%]增高(P<0.05);2组干预后各指标比较差异无统计学意义(P>0.05)。对未转复窦性心律患儿,对照组干预后心率[(201.61±25.50)次/min]较干预前[(221.35±12.30)次/min]减慢,收缩压[(60.52±2.89)mm Hg]较干预前[(62.83±3.85)mm Hg]下降(P<0.05),左室射血分数[(60.22±10.81)%]与干预前[(63.82±8.20)%]比较差异无统计学意义(P>0.05);观察组干预后心率[(216.44±14.32)次/min]、收缩压[(63.78±6.28)mm Hg]和左室射血分数[(62.56±7.32)%]与干预前[(218.06±13.81)次/min、(64.39±6.15)mm Hg、(62.28±6.95)%]比较差异无统计学意义(P>0.05),且干预后心率较对照组快,收缩压较对照组高(P<0.05)。结论对婴儿先天性心脏病术后早期并发室上性心动过速,采用经食管心房调搏术治疗具有与静脉泵注胺碘酮相同的效果,且转复窦性心律所需时间较短,对循环的影响较小,不增加不良反应发生率。
Objective To compare the efficacy of transesophageal atrial pacing versus intravenous amiodarone on supraventricular tachycardia in early period after cardiac surgery in infants with congenital heart disease.Methods In 82 infants with congenital heart disease,48 infants received intravenous injection of amiodarone(control group)and 34 patients received transesophageal atrial pacing(observation group)to treat supraventricular tachycardia in early period after cardiac surgery.The effective rate,the time for conversion to sinus rhythm and the incidence of adverse reactions,as well as the heart rate,invasive systolic blood pressure(SBP)and left ventricular ejection fraction(LVEF)before and after intervention were compared between two groups.Results The rate of successful conversion to sinus rhythm and the incidence of adverse reactions showed no significant differences between observation group(47.06%,20.59%)and control group(52.08%,6.25%)(P>0.05).Observation group needed shorter time to convent to sinus rhythm than control group((10.63±3.86)min vs.(26.20±11.25)min)(P<0.05).In infants with successful conversion to sinus rhythm in observation group and control group,the heart rates were slower after intervention((146.69±16.64),(139.48±15.50)beats/min)than those before intervention((222.81±12.89),(222.24±8.80)beats/min)(P<0.05),while SBP((84.06±10.90),(81.20±9.11)mm Hg)and LVEF((61.94±6.09)%,(61.72±11.37)%)after intervention were higher than those before intervention(SBP:(62.50±4.77),(62.60±6.19)mm Hg;LVEF:(59.94±6.36)%,(60.20±12.27)%)(P<0.05),and all above showed no significant differences between two groups(P>0.05).In infants without successful conversion to sinus rhythm,the heart rate was slower and SBP was lower after intervention((201.61±25.50)beats/min,(60.52±2.89)mm Hg)than that before intervention((221.35±12.30)beats/min,(62.83±3.85)mm Hg)(P<0.05),while LVEF showed no significant difference after intervention compared with that before intervention((60.22±10.81)%vs.(63.82±8.20)%)in control group(P>0.05);the heart rate,SBP and LEVF showed no significant differences after intervention((216.44±14.32)beats/min,(63.78±6.28)mm Hg,(62.56±7.32)%)compared with those before intervention((218.06±13.81)beats/min,(64.39±6.15)mm Hg,(62.28±6.95)%)in observation group(P>0.05);the heart rate was faster and SBP was higher after intervention in observation group than that in control group(P<0.05).Conclusion Transesophageal atrial pacing has the similar efficacy as intravenous amiodarone on supraventricular tachycardia in early period after cardiac surgery in infants with congenital heart disease,and it has shorter time to convent to sinus rhythm,less influence on circulatory and no increasing of adverse reactions.
作者
吴开元
吴蕊
李斌
WU Kaiyuan;WU Rui;LI Bin(Heart Center,Henan Provincial People’s Hospital,Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华实用诊断与治疗杂志》
2020年第7期703-706,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划项目(201702221)。
关键词
先天性心脏病
经食管心房调搏
室上性心动过速
婴儿
congenital heart disease
transesophageal atrial pacing
supraventricular tachycardia
infants
