12例胎儿室上性心动过速的治疗

Treatment for 12 cases with fetal superventricular tachycardia

目的研究胎儿心动过速的临床治疗方案。方法回顾性分析2011年1月至2015年12月在广州医科大学附属第三医院胎儿医学科进行系统超声检查的45 566例孕妇的结果,59例(3.62‰)通过胎儿超声心动图和M型超声诊断为胎儿心律不齐,其中12例诊断为胎儿室上性心动过速(superventricular tachycardia,SVT),对3例SVT病例分别给予盐酸普罗帕酮、美托洛尔和地高辛治疗,另外9例患者给予期待治疗并积极治疗母体并发症。结果 3例药物治疗患者中1例伴有胎儿水肿经药物治疗无效选择终止妊娠,另外2例治疗效果良好,其胎儿健康;9例期待治疗患者中,1例13周发生胎死宫内,1例孕18+6周发生难免流产,1例孕35+6周合并中央性前置胎盘采取剖宫产分娩,其余6例患者预后良好,足月分娩。结论胎儿发生阵发性室上性心动过速不伴有水肿,可予期待治疗,结局良好;胎儿发生持续性室上性心动过速不伴有水肿,可经药物治疗转律效果良好,若伴有严重水肿,药物治疗效果较差。

Objective To study the clinical treatment decisions of fetal superventricular tachycardia（ SVT）.Methods By analyzing retrospectively the ultrasound outcomes of 45 566 pregnant women who had systematic ultrasound examination in The Third Affiliated Hospital of Guangzhou Medical University from January 2011 to December 2015,we found that there were 59 cases（ 3.62‰） diagnosed with arrhythmia through fetal echocardiography and M-mode ultrasonography,including 12 cases of fetal superventricular tachycardia.Among these 12 cases,3 cases of persistent superventricular tachycardia were given propafenone hydrochloride,metoprolol and digoxin medication respectively,while the other 9 cases were given expectation treatment.Results Among the 3 cases of medicine treatment,the patient with fetal edema chose to terminate the pregnancy after treatment failure; the other 2 cases had effective outcome that fetuses were healthy.Among the 9 cases with expectation treatment,one case had intrauterine fetal death at gestational week of 13^ thweek,one patient occurred inevitable abortion at gestational week of 18^ thweek and6 days,one patient performed cesarean delivery at gestational week of 35^ thweek and 6 days because of complete placenta previa,the remaining 6 cases had favorable prognosis and delivered at term.Conclusions Without fetal edema,fetuses of paroxysmal SVT got well through expectant management.The fetuses of persistent SVT without edema could recover sinus rhythm through drug therapy.While fetuses of persistent SVT complicated with severe edema,drug treatment effect is poor.