摘要
目的:探讨新生儿低钙血症所致房室传导阻滞(AVB)的发生机制,分析不同治疗方法对新生儿低钙血症所致AVB的临床效果。方法:分析21例新生儿入院期间低钙血症引起QT间期异常延长,导致2∶1AVB临床经过;并对其进行随机分组,8例给与异丙肾上腺素(异丙肾),13例应用10%葡萄糖酸钙静脉滴注,心电监护观察两组AVB的纠正情况。结果:21例患儿中早产儿19例,母亲产前有病理情况18例。入院诊断:新生儿窒息14例,新生儿肺炎4例,宫内感染2例,新生儿低血糖症1例。21例患儿均于入院(72±9)h内出现QT间期延长致功能性的2∶1 AVB,QT间期从入院时(0.278±0.031)s水平延长至(0.594±0.028)s(t=3.155,P<0.01),同时血清离子钙浓度从入院时的(1.12±0.019)mmol/L降至(0.35±0.051)mmol/L(t=3.924,P<0.01),QT间期的延长程度与离子钙降低程度呈正相关(r=0.562,P<0.01)。21例新生儿患者中,葡萄糖酸钙组恢复窦性心律所用时间(0.35±0.16)h明显少于异丙肾组(6.3±2.3)h;两组差异有统计学意义(t=7.255,P<0.005)。结论:新生儿低钙血症可引起QT间期异常延长,导致功能性的2∶1 AVB。其高危因素有围产期窒息、早产儿、感染、母亲产前出现病理情况。药物治疗10%葡萄糖酸钙效果优于异丙肾。
Objective: To explore the mechanism of bradyarrhythmia occurred in neonatal hypocalcaemia,analyze the clinical effectiveness of different therapeutics.Methods: 21 neonate's clinical manifestations of hypocalcaemia with long QT interval and 2∶1 A-V block hospitalized in the NICU were analyzed.The newborn were classified into 2 groups,8 were treated by isoproterenol,the other 13 were treated by 10% calcium gluconate.Observed the time of AVB were retrieved by invigilator.Results: Among them 19 cases were preterm infant.18 cases of them,the mother had pathological disease before they delivery.14 cases were diagnosed as neonatal asphyxia,and 4 as neonatal pneumonia,2 as intrauterine infection,1 as neonatal hypoglycemia.The QT interval were(0.278±0.031)s and prolonged to(0.594±0.028)s while 2∶1 A-V block be detected(t=3.155,P<0.01).The mean calcium concentration was admission(1.12±0.019)mmol/L.It decreased to(0.35±0.051)mmol/L when functional 2∶1 A-V block occurred(t=3.924,P<0.01),there was a positive correlation between the prolonged extent of QT interval and the degrade level of calcium concentration(r=0.562,P< 0.01).The time of AVB were retrieved to sinus rhythm in group of isoproterenol was(6.3±2.3)h,in group of calcium gluconate was(0.35±0.16)h.There was a significant difference between them(t=7.255,P<0.005).Conclusion: Neonatal hypocalcaemia can cause long QT interval and functional 2∶1 A-V block.The treatment principles is close monitoring of the serum calcium,especially for premature,asphyxia,infection infant,and administration of calcium when AVB is occurred.
出处
《天津医科大学学报》
2010年第4期662-664,共3页
Journal of Tianjin Medical University
