胎儿心律失常的原因及对胎儿预后的影响

The common causes of fetal arrhythmia and the influences after prognosising

目的:总结胎儿心律失常原因,进一步探讨胎儿心律失常对胎儿预后的影响.方法:采用回顾性分析方法,对21例胎儿心律失常孕妇的情况,胎儿心律失常的临床表现、诊断方法,结合长期随诊结果进行总结.结果:胎儿心律失常的发生率为0.3%.21例胎儿心律失常中,4例为胎儿心动过:速(19.0%),3例为胎儿心动过缓(14.3%),14例为不规则胎儿心律(67.7%);胎儿心律失常平均诊断孕周岁36+2周(28周～41+1周).21例中18例为产前胎心听诊时发现胎儿心律失常;3例胎心监测发现胎儿心律失常.6例产前进行了胎儿超声心动检查,其中2例胎儿超声心动检查提示胎儿室性早搏,心脏结构未见异常,占33.3%,余未见异常.产后新生儿均存活,随诊20例(95.2%),10例新生儿进行了超声心动检查,其中1例诊断为先天性心脏病,为法洛四联症.先天性心脏病新生儿在心律失常胎儿中发生率为4.8%.结论:大多数心律失常的胎儿预后是好的,心脏畸形的发生率很低.对于持续性心率慢的胎儿,需注意心脏结构异常的存在;对于心律失常胎儿的处理采用期待疗法,根据产科指征决定终止妊娠的方式.

Objective: To summarize the common causes of fetal arrhythmia and explore its clinical significance and correlation with fetal prognosis. Methods: 21 cases of fetal arrthythmias, the clinical situation and diagnostic procedure as well as the results of long-term follow-up were analyzed retrospectively. Results: The incidence of fetal arrhythmias was 0.9%, 19.0%(4/21)of them were diagnosed fetal tachycardia, 14.3%(3/21) of them were diagnosed fetal bradycardia and 67.7%(14/21) were diagnosed irregular fetal cardiac rhythm. They were diagnosed at the average of 36+2 weeks gestation(28 weeks to 41+1 weeks). 18 cases were diagnosed by antenatal fetal ausculation, 3 cases were diagnosed by fetal heart monitoring. We performed fetal echocardiograms on 6 fetuses. 2 cases(33.3%) showed that premature atrial contraction with normal structure of fetal heart. All of the neonates survived postnatally and 20 of them(95.2%) accepted follow-up. Echocardiograms for 10 neonates were performed and 1 of them was identified as tetralogy of Fallot with normal heart rhythms. The incidence of structure heart disease in fetal arrhythmia is 4.8%. Conclusion: The prognosis was well for the most of the fetuses with arrhythmias, the incidence of structure heart disease was very low among them. We should pay attention to diagnose the fetus of structure heart disease with persistant bradycardia, emporization for the management of arrhythmiatic fetuese should be accepted and the decision for termination of pregnancy should be made according to obstetric indication.