直流同步电复律终止婴儿及儿童阵发性室上性心动过速

Dc Synchronized Cardioversion in Termination of Paroxysmal Supraventricular Tachycardia in Infants and Children

1984年11月以来,26例婴儿及儿童28次阵发性室上性心动过速接受了直流同步电复律治疗。电击前均经常规治疗无效。年龄9天～13岁,中位年龄4个月。电复律成功率73%。发作时体表心电图无 P 波,P-R/R-R≥0.50,P 波在Ⅱ、Ⅲ、aVF 导联倒置且 P-R 小于正常值下限,以及在窦性心律时表现有预激综合征者,电复律效果尤佳,有房室分离者对电复律无效。成功病例,每例电击1～2次,每次电量0.8～1.6J/kg。电击后1例出现房扑,再次电击后恢复窦律,3例出现短阵室速或室早,0.5～2分钟后自然消失。18例有心衰者,13例成功,心衰消失或减轻,其余5例心衰未加重。

From November 1984 to April 1990,26 patients with 28 episodes of PSVT unres-pending to conventional treatment underwent cardioversion.The success rate was73%.After cardioversion,one patient developed atrial flutter and the sin us rhythmwas resumed by repeated shock;three patients developed transient ventricu lar tachy-cardia or extrasystole but the arrhythmia disappeared in one or two minutes spon-taneously.In 13 of the 18 patients with heart failure,cardioversion was success-ful,the circulatory failure disappeared soon or was alleviated obviously;in the re-mianing 5 patients,it did not aggravate the condition.It was suggested that cardio-version was especially effective in the treatment of PSVT with no P wave,P-R/R-R≥0.50,inverted P with P-R less than normal and manifest WPW,but not ofPSVT with A-V dissociation.One or two times of shock(0.8～1.6J/kg)seemed to beadequate.