新生儿阵发性室上性心动过速28例临床分析

Clinical analysis of 28 cases of paroxysmal ventricular tachycardia in newborn

目的分析新生儿阵发性室上性心动过速（PSVT）的临床特点、治疗过程及临床预后情况，提高临床的诊治水平。方法对我院2010年1月～2015年6月28例新生儿PSVT的病历资料进行回顾性分析，分别采用冰敷（n=23）、ATP（n=10）、普罗帕酮（n=13）、胺碘酮（n=10）治疗，比较各种不同治疗方法的成功转复率、复发率及随访情况。结果在PSVT新生儿中，男多于女，于新生儿早期≤7d，发病的以早产儿为主，于新生儿后期〉7d发病的以足月儿为主。出现预激综合征的发生率较高67．9％。在新生儿PSVT治疗上，ATP、普罗帕酮、胺碘酮比较，以胺碘酮复律成功率最高，复发率最低，其中冰敷与ATP、普罗帕酮、胺碘酮比较，差异有统计学意义（X^2=6．231,6．865，7．231，P〈0．05）；胺碘酮与冰敷、ATP治比较，差异有统计学意义（X^2=4．931，4．164，P〈0．05），胺碘酮与普罗帕酮比较，差异无统计学意义（X^2=2．643，P〉0．05）。在随访中发现新生儿PSVT的复发率较高，达33．3％，感染为主要诱因，达78．9％。结论新生儿PSVT如及时处理，较少发生心力衰竭及心源性休克，预后良好。于新生儿PSVT发作时，胺碘酮可作为一线药物应用。感染为患儿出现PSVT后期复发的主要诱发因素。

Objective To analyze the clinical characteristics, treatment process and clinical outcome of paroxysmal ventricular tachycardia in newborn, and to improve the level of clinical diagnosis and treatment. Methods 28 cases of newborns with PSVT cured in our hospital from January 2010 to June 2015 were retrospectively analyzed. They were treated with ice deposited （n=23）, ATP （n=10）, amiodarone （n=10） treatment respectively. The success rate, relapse rate and follow-up of different treatment methods were compared. Results In PSVT newborns, male was more than female, the onset was mainly premature neonates when less than 7 days, the onset was mainly in full-term infants when the post neonatal 〉 7 days. The occurrence rate of the emergence of the pre excitation syndrome was 67.9%. In the treatment of neonatal PSVT, comparison of ATP, propafenone and amiodarone, amiodarone had the highest success rate and the lowest recurrence rate. Compared Ice compress with ATP, propafenone, amiodarone, the difference was statistically significant （X^2=6.231, 6.865, 7.231,P 〈 0.05）. Comared Amiodarone with ice compress and ATP, the difference was statistically significant （X^2=4.931, 4.164,P ~ 0.05）. Compared amiodarone with propafenone, the difference was not statistically significant （X^2=2.643, P 〉 0.05）. During follow-up, the recurrence rate of neonatal PSVT was higher, reaching 33.3%, and the infection was the main cause, reaching 78.9%. Conclusion For neonatal PSVT, it is important to treattimely, it has less heart failure and cardiac shock, and it has good prognosis. Amiodarone can ire used as a first-line drug in the neonatal PSVT attack. Infection isthe main predisposing factor for PSVT recurrence in newborn.