儿童先天性和获得性完全性房室传导阻滞临床资料分析

Study of children patients with congenital and acquired completely atrio-ventricular block

目的:探讨儿童先天性和获得性完全性房室传导阻滞(CAVB)的病因、临床特点、心电图表现、治疗及预后。方法:对32例CAVB患儿临床资料进行回顾性分析和总结。结果:①32例CAVB患儿中,先天性CAVB14例,获得性CAVB18例;②14例先天性CAVB患儿中,好转10例,死亡3例,失访1例;③18例获得性CAVB患儿中治愈5例,好转4例,无效6例(其中3例已安装永久起搏器),死亡3例。结论:先天性CAVB可为母患结缔组织病或先天性心脏畸形导致,心肌炎为儿童期获得性CAVB的主要病因。先天性CAVB的患儿如出现心室率慢、频繁阿-斯综合征发作、心电图伴有束支传导阻滞和Q-T间期延长者,预后差;心肌炎所致CAVB的预后取决于在急性期是否得到及时有效的治疗。除病因治疗外,静脉应用大剂量肾上腺皮质激素、异丙肾上腺素增加心室率、及时安装临时起搏器治疗对预后很重要。

Objective： To discuss the cause, clinical characteristic, electrocardiogram performance, treatment and prognosis of children＇s congenital and acquired completely atrio-ventricular block （CAVB）. Method： We collected the data of 32 patients with CAVB from 1984-08 to 2005-03. We reviewed and summarized the data. Result： ①There were 14 congenital CAVB patients and 18 acquired CAVB patients. ②In 14 congenital CAVB patients 10 changed for the better, 3 died and 1 was lost. ③In 18 acquired CAVB patients 5 were cured, 4 changes for the better, 6 were of no effect （3 patients were installed permanent pacemaker） and 3 died. Conclusion： Mother with connective tissue disease or congenital heart disease and myocarditis were the etiologital foetors for congenital and acquired CAVB respectively. ①If congenital CAVB patients appear the ventricular rate slowly, frequent AdamsStokes and bundle block and with Q-T extension, the prognosis is bad. ②The CAVB prognosis caused by myocarditis is depended on whether obtaining the prompt effective treatment, besides etiological treatment, the vein application large dose adrenal cortex hormone, the isoprenaline increasing ventricle rate. Prompt installment temporary actuator treatment is very important to the prognosis.