小儿阵发性室上性心动过速的复律药物个体化治疗分析

Individualized Treatment of Cardioversion Medicines on Paroxysmal Supraventricular Tachycardia in Children

目的探讨三磷酸腺苷(ATP)、胺碘酮、普罗帕酮复律药物在小儿阵发性室上性心动过速(PSVT)个体化治疗中的临床应用价值。方法回顾性分析126例药物复律成功PSVT患儿临床资料,根据其初次复律效果分成首次复律成功组(n=95)和多次复律成功组(n=31);根据首次复律成功使用药物种类将首次复律成功组患儿分成ATP组(A组,n=32)、胺碘酮组(B组,n=32)和普罗帕酮组(C组,n=31)3个亚组。A组采用快速弹丸式静脉推注ATP方案,B组采用静脉推注胺碘酮方案,C组采用静脉推注普罗帕酮方案。比较A,B,C组患儿平均复律时间、年龄、性别、家族遗传病史、体质量指数、合并症等指标,分析首次复律成功组患儿及多次复律成功组患儿年龄、性别、家族遗传病史、体质量指数、合并症等临床资料差异,记录不良反应发生情况。结果首次复律成功的3个亚组患儿在性别、体质量指数、家族遗传病史等一般资料方面比较,差异均无统计学意义;A组患儿平均复律时间最短,为(6.5±1.8)s,其次为C组患儿,为(410.6±69.4)s,B组患儿平均复律时间最长,为(993.5±98.4)s,3组比较差异具有统计学意义(F=18.462,P=0.000);A组中年龄≤5岁患儿仅4例,为3组中最少,其次为C组,B组中年龄≤5岁患儿最多,3组比较差异具有统计学意义(P<0.05);A组与C组均以无合并症状患儿居多,B组中有合并症患儿最多(以心功能不全患儿居多),差异具有统计学意义(P<0.05)。首次复律成功组和多次复律成功组患儿在性别、体质量指数方面比较,差异无统计学意义。但首次复律成功组和多次复律成功组患儿在年龄方面的差异有统计学意义(P<0.05),此外,多次复律成功组患儿有合并症者比例为83.9%(26例),存在家族遗传病史者比例为54.8%(17例),均明显高于首次复律成功组患儿比例为54.7%(52例)和26.3%(25例),差异具有统计学意义(P<0.05)。首次复律成功组患儿中21例发生不良反应,发生率为22.1%。其中,A组患儿不良反应发生率最高(37.5%),其次为C组(25.8%),B组不良反应发生率最低(3.1%),组间比较差异具有统计学意义(P<0.05);多次复律成功组患儿不良反应发生率为64.5%,明显高于首次复律成功3个亚组,组间比较差异具有统计学意义(P<0.05)。结论 3种药物单次复律效果各有优劣,低龄、存在合并症及家族遗传病史的患儿首次复律治疗成功率较低,需引起临床重视;多次复律治疗可能会增加不良反应发生率,临床医生应当根据PSVT患儿实际病情给予个体化治疗方案,以此提高复律效果,改善其预后水平。

Objective To investigate the clinical value of cardioversion medicines of adenosine triphosphate（ATP）,amiodarone and propafenone in the individualized treatment of paroxysmal supraventricular tachycardia（PSVT）in children.Methods The clinical data of 126 cases of successful drug cardioversion of PSVT in children were retrospectively analyzed.According to the effect of initial cardioversion,they were divided into a first successful cardioversion group（n=95）and a multiple cardioversion group（n=31）;according to the types of medicines,the first successful cardioversion group was divided into three sub-groups：ATP（Group A,n=32）,amiodarone（Group B,n=32）and propafenone（Group C,n=31）.Group A were given rapid bolus intravenous injection of ATP,Group B were given intravenous injection of amiodarone and Group C were given intravenous injection of propafenone.Indicators of average time of cardioversion,age,gender,family genetic history,body mass index and complications in children were compared among Group A,B and C.The clinical data of the first successful cardioversion group and the multiple cardioversion group were analyzed children′s age,gender,family genetic history,body mass index and complications and adverse reactions were recorded.Results There were no statistically significant differences in gender,body mass index and family genetic history among Groups A,B and C.The shortest average time of cardioversion was（6.5±1.8）s of Group A,the shorter time was（410.6±69.4）s of Group C,the longest time was（993.5±98.4）s of Group B,and the differences among the three subgroups were statistically significant（F=18.462,P=0.000）.There were lest cases（only four cases）of children aged no more than five in Group A,there were less cases in Group C,cases of children aged no more than five in Group B were the most,and the difference was statistically significant（P〈0.05）.Most of the children in Groups A and C had no complications while most of the children in Group B had complications（mostly cardiac functional insufficiency）and the difference in complications was statistically significant（P〈0.05）.There were no significant differences in gender and body mass index between the first successful cardioversion group and the multiple cardioversion group but there was statistically significant difference in age between the two groups（P〈0.05）.In addition,（83.9%）26cases of children of the multiple cardioversion group had complications,54.8%（17cases）had family genetic history,which were both higher than the first successful cardioversion group of 54.7%（52cases）and 26.3%（25cases）,and the differences between the two groups were statistically significant（P〈0.05）.21 cases of the first successful cardioversion group had adverse reactions and the incidence was 22.1%.The incidence of adverse reactions in Group A was the highest（37.5%）,followed by Group C（25.8%）and Group B（3.1%）,and the difference among the three groups was statistically significant（P〈0.05）.The incidence of adverse reactions in the multiple cardioversion group was 64.5%,significantly higher than the three subgroups（Groups A,B and C）of the first successful cardioversion group,and the difference between groups was statistically significant（P〈0.05）.Conclusion The effects of the three medicines on single cardioversion are different and children with lower age,complications and family genetic history have low rate of the first successful cardioversion,which needs to be paid attention in the clinical treatment.Multiple cardioversion therapy may increase the incidence of adverse reactions and the clinician should make individualized treatment plan based on the actual condition of children with PSVT in order to improve the effect of cardioversion and improve their prognosis level.