心脏临时起搏治疗小儿心律失常

Temporary cardiac pacing for the treatment of arrhythmias in children

目的了解心腔心内膜临时起搏治疗在儿科的应用。方法对１８例（其中伴阿斯发作１７例）于入院后进行右心腔心内膜临时起搏治疗，起搏阈值１～２Ｖ，起搏电压３～５Ｖ，起搏频率７０～１００次／分，起搏时间１．５～１３天。起搏前静脉滴注异丙基肾上腺素，伴发心力衰竭及休克者予多巴胺、硝普钠、地戈辛。结果１６例起搏治疗后阿斯发作消失，循环改善，Ⅲ度房室传导阻滞（ＡＶＢ）、高度ＡＶＢ、扭转室速、室颤消失，均救治成活，因室速起搏死亡１例，安置预防性起搏１例。结论心脏内临时起搏是治疗小儿慢性或某些快速型心律失常伴阿斯发作的首选方法，疗效满意。对Ⅲ度ＡＶＢ或高度房室传导阻滞的患儿虽未有阿斯发作，但因手术或伴有先天性心脏病需进行心血管造影或手术时，安置预防性临时心脏起搏以防止麻醉、手术中意外。

Objective To evaluate the therapeutic role of temporary endocardiac pacing in paediatrics . Methods Totally 18 cases were treated by temporary cardiac pacing in right ventricle after admission with a pacing threshold of 1～2 v, pacing voltage of 3～5 v, pacing frequency of 70～100/min and pacing time of 1.5～13 d. Before pacing 16 cases of Adams Stokes syndrome received intravenous isoprenaline and 3 of congestive heart failure and cardiogenic shock received intravenous dopamine, sodium nitroprusside and digoxin. Results In 15 cases of acute viral myocarditis, 9 cases were cured. Residual abnormalities of electrocardiogram were left over in 5 cases. One case died. Two cases of congenital Ⅲ° AVB were necessitated the preventive temporary cardiac pacing. Torsades des pointes and ventricular fibrillation disappeared after pacing in one case suffering from LQTS with torsades des pointes and ventricular fibrillation. Conclusion The indications of temporary cardiac pacing are acute bradycardia, techycardia and torsades des pointes with Adams Stokes syndrome. In children suffering from Ⅲ° AVB and high degree AVB without Adams Stokes syndrome the temporary cardiac pacing is necessary before applying cardiac catheterization, cardioangiography and cardiac operation or other operations in order to prevent accident.