小儿室上性心动过速87例临床分析和治疗药物选择

Clinical characteristics and treatment of 87 children with supraventricular tachycardia

目的探讨小儿室上性心动过速(SVT)诊断和分型中体表心电图的价值以及如何合理应用治疗SVT的药物。方法分析87例经过电生理检查的SVT患儿临床资料。结果89.7%的病例能通过体表心电图正确诊断及定位。SVT构成比为:房室折返性心动过速(AVRT)66.7%,房室结折返性心动过速(AVNRT)27.6%,其他5.7%。AVRT患儿应用普罗帕酮转复率为94.9%,维拉帕米为71.4%,ATP为75.0%,地高辛为62.5%;AVNRT用普罗帕酮转复率为83.3%,维拉帕米为90.0%,ATP为100.0%,地高辛为66.7%。药物不良反应发生率为:普罗帕酮14.8%,维拉帕米31.6%,ATP18.8%,地高辛18.2%。结论正确运用体表心电图诊断和定位以及药物治疗能有效地解决小儿SVT的诊疗问题,几种治疗SVT的药物对不同类型SVT的治疗价值各不相同,应用时应遵循一定的原则。

Objectives To investigate the diagnostic value of surface electrocardiogram in children with supraventricular tachycardia （SVT） and to evaluate the efficacy of different drugs in its treatment. Methods Clinical data of 87 SVT cases diagnosed with electrophysiology examination were studied. Results （1） With surface electrocardiogram 78 （89.7%） cases could be diagnosed as well as classified correctly; （2） Among them, atrioventricular reentrant tachycardia （AVRT） was 66.7% （58）, atrioventricular nodal reentrant tachycardia （AVNRT） was 27.6% （24）, 3 cases were found organic heart disease, 4 cases presented heart failure followed SVT; （3） In treating AVRT patients, propafenone, ATP, verapamil, digoxin worked successfully with 94.9%, 75.0%, 71.4%, 62.5% respectively, while propafenone, ATP, verapamil, digoxin were successful in treating AVNRT patients with 83.3%, 100%, 90.0% and 66.7% respectively. Verapamil was effective in treating one sino-atrial node reentry case; amiodarone was effective in treating 2 automatic atrial tachycardia cases and 1 chaotic atrial tachycardia （CAT） case, but failed in another CAT. （4） Adverse effect rate of propafenone, verapamil, ATP, digoxin were 14.8%, 31.6%, 18.8% and 18.2% respectively. No obvious adverse effects were found in 4 cases treated with amiodarone. Conclusions Surface electrocardiogram is an effective method to diagnose and classify SVT. Efficacy of drugs is varied with different types of SVT. Certain principles shall be observed for clinical application in drug choice of SVT＇s treatment.