小儿室性心动过速的诊治和预后分析

Diagnosis and prognosis following therapy of ventricular tachycardia in children

目的 探讨小儿室性心动过速(室速)的临床特征和治疗预后。方法 39例室速经心电图和24 h动态心电图检查确诊。超声心动图和实验窒检查明确是否合并器质性心脏病和心功能状况。选用有效抗心律失常药控制室速。结果 单纯性室速26例;多形性室速9例;尖端扭转型室速(TDP)4例。34例有器质性心脏病。选用利多卡因或普罗帕酮等治疗,29例室速有效控制,2例顽固反复,1例安置心脏起搏器,7例死亡。结论 小儿室速多数发生于器质性心脏病,心电图是诊断室速的主要方法。利多卡因、普罗帕酮治疗室速有明显疗效。单纯性室速预后较好;重症病毒性心肌炎、扩张性心肌病合并严重心力衰竭的多形性室速及扭转型室速,预后差、死亡率高。

Objective To summarize 39 patients with ventricular tachycardia(VT) and to evaluate the clinical fea-tures and prognosis following treatment. Methods Definitive diagnosis of all cases was made by electrocardio-graphy and 24-hour Holter. Echocardiography and laboratory examinations were carried out to detect the heart disease and cardiac function. Appropriate anti-arrhythmic drugs were given to control VT. Results Twenty-six patients were found out with monomorphic VT,9 with polymorphic VT and 4 with torsade de points(TDP) and 34 cases with organic heart disease. Lidoeaine, propafenone and other drugs were used to treat VT with 29 cases under control; pacemaker was implanted in 1 case. Seven cases were dead. Conclusion VT often occurs in the children with organic heart disease while it is rare in normal children. Electrocardiogram is the main method for the diagnosis of VT. Lidoeaine can control most of the VT attacks; propafenone also shows obvious effects on the stacks. The prognosis of polymorphic VT,TDP with severity virus myocarditis, dilated cardiomyopathy with severe heart failure is poor,it is better in monomorphic VT.