超声心动图对胎儿室上性心动过速的诊断及宫内治疗疗效评价

Prenatal echocardiographic diagnosis of fetal supraventricular tachycardia treated with digitalis

目的 探讨超声心动图在胎儿快速心律失常诊断及宫内治疗疗效评价中的应用价值.方法 对135例心动过速胎儿分别行M型及多普勒超声心动图检测,其中32例为室上性心动过速(200次/min≤心室率≤310次/min).对无合并先天性心脏病的胎儿进行母亲常压氧治疗或宫内洋地黄转律治疗,并对比治疗前后超声心动图改变.结果 32例室上性心动过速胎儿中合并复杂先天性心脏病者7例,胎儿水肿10例.对7例合并心脏畸形的胎儿终止妊娠;对12例阵发性室上性心动过速和2例心动过速持续发作48～72 h、且心室率＜250次/min的胎儿行保守治疗,其中8例恢复正常心律和心率,6例转为频发房性早搏伴短阵室上性心动过速并提前分娩;对持续发作组11例(心室率≥250次/min)胎儿经胎盘给洋地黄治疗后均转律成功,其中4例重度水肿胎儿治疗转律时间为15～27 d,余7例转律时间为10～15 d.出生后新生儿随访期最长24个月,头颅CT、超声心动图等检查显示各项生理指标均正常.结论 超声心动图可迅速检出胎儿心律失常,并明确性质.对室上性心动过速胎儿经胎盘给西地兰+地高辛可有效转律,并同时控制胎儿心力衰竭和减轻水肿.

Objective To evaluate the diagnosis of supraventricular tachycardia treated with digitalis on prenal echocadiography. Methods Totally 135 fetuses of 22-38 weeks gestational ages were found to have tachycardial arrthythmia on prenal echocardiography. Results In the 135 cases there were 32 cases with supraventricular tachycardia (SVT). Seven fetuses with SVT had congenital heart disease and hydrops diagnosed on Doppler echocardiography. Another 25 fetuses with SVT had no congenital heart disease, 11 of whom were treated with transplacental digitalis resulting in excellent responses. The longest time that following up a case by regullar visits to the newbron was 24 monthes. Each physiological index like head CT or echocardiography was normal. Conclusions The fetal echocardiography is an essential and effective method for the diagnosis of fetal tachcardial arrhythmia. The transplacental digoxin intervention therapy may be the first choice in the treatment of the fetal tachyarrhythmia.