摘要
目的探讨新生儿尤其是早产儿严重窒息缺氧复苏后缓慢性心律失常的发生机制及治疗原则。方法回顾性分析9例严重窒息患儿复苏后出现QT间期异常延长导致功能性2∶1房室传导阻滞(AVB)临床经过。结果9例患儿年龄(3.3±1.6)h;胎龄(31.6±3.0)周;出生时体重(1776.1±646.3)g;入院诊断:产时重度窒息7例,吸入性肺炎2例。均于入院35h内出现进行性QT间期延长致功能性的2∶1AVB,QTc(791.6±139.9)ms,且血清离子钙浓度从平均1.02mmol/L,降至0.32mmol/L。经肾上腺素、大剂量VitC、葡萄糖酸钙、果糖,并予纠正酸中毒及其他对症治疗。治愈3例,死亡6例。结论QT间期异常延长导致功能性的2∶1AVB是新生儿尤其是早产儿严重窒息缺氧后出现的一种缓慢性心律失常,预后不良。治疗关键在于预防。
Objectives To explore the mechanism and the treatment of bradyarrhythmia occurred in neonates and premature infants resuscitated from severe asphyxia and hypoxia. Methods Clinical manifestations of 9 neonates with long QT interval and 2 ： 1 A-V block hospitalized in the NICU of Shanghai Children＇ s Medical Center were retrospectively analyzed. Results Among them six cases were male and 3 cases were female. The medium age at admission was 3.3 ± 1.6 hour. The mean gestational age was 31.6 ± 3.0 weeks. The average birth weight was 1776.1 ± 646.3 gram （930-2160 g）. Seven cases were diagnosed as having severe birth asphyxia, and two with severe aspiration pneumonia. The QTc were 791.6 ± 139.9 ms while 2 ： 1 A-V block be detected. The mean calcium concentration was 1.02 mmol/L （above 0.9 mmol/L was considered as normal）. It decreased to 0.42 mmol/L when functional 2 ： 1 A-V block occurred and it further decreased to 0.32 mmol/L in six patients before death. Three regained normal QT interval and survived, while other six neonates died after administration of adrenalin, large dose of vitamin C and calcium. Conclusions Acquired long QT interval would result in functional 2 ： 1 A-V block. The treatment principles for the suspected patients, especially for premature infant, should include prevention of myocardial injury from oxygen free radicals, preservation of heart function with inotropic drugs if necessary, close monitoring of the serum calcium and ECG and administration of calcium.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2008年第12期1049-1051,1055,共4页
Journal of Clinical Pediatrics
