胎儿阵发性室上性心动过速的超声诊断及治疗

Echocardiographic diagnosis and evaluation of fetal paroxysmal upraventricular tachycardia and normobaric oxygen therapy

目的探讨胎儿阵发性室上性心动过速(SVT)的产前超声诊断方法及常压氧疗法的疗效。方法应用胎儿多普勒超声心动图对从2250例心律失常胎儿中遴选的29例阵发性SVT进行心率、心律变化的分析,采用常压氧疗法治疗干预并对治疗前后胎儿心功能指标进行比较。结果29例阵发性SVT胎儿均于检查后行常压氧治疗干预,第1个疗程转律15例,第2个疗程转律12例(含3例转偶发早搏);1例发生频发房性早搏;1例10d后发生持续性SVT。两个疗程常压氧治疗总有效率为93.1%。治疗前后心脏各指标对比明显改善。结论胎儿阵发性室SVT多由频发房性早搏导致,通常不出现心功能异常。常压氧疗法可有效抑制短阵房性心动过速,改善胎儿循环功能及提高血氧饱和度。

Objective To evaluate the diagnosis of fetal paroxysmal supraventricular tachycardia （PSVT） and the effect of normobaric oxygen therapy by echocadiography. Methods A total of 2250 fetuses with arrhythmi, 29 cases with PSVT were analyzed with rhythm and rate of fetal heart before and afer applying maternal noimobaric oxygen therapy. Results Of 29 fetuses with PSVT, 15 cases converted to normal heart rhythm in the first period of treatment , 12 cases did in the second period （including 3 cases converted to accidental premature beats） , one ease converted to frequently atrial premature beat, and one case oceured continual SVT 10 days later. The totally effective rate reached 93.1% in two period of normobaric oxygen treatment. The cardiac parameters showed significant improvement after treatment. Conclusions The fetal PSVT was mainly caused by frequent atrial premature beat without abnormal heart function. The maternal normobaric oxygen therapy may be efficient to treat paroxysmal atrial tachycardia and improve fetal circulation and oxygen saturation.