儿童完全性房室传导阻滞临床分析

Clinical characteristics of complete atrioventricular block in children

目的探讨完全性房室传导阻滞(CAVB)患儿的临床特点及治疗转归。方法选取2007—2015年首都医科大学附属北京儿童医院收治的CAVB患儿78例,对其发病年龄、病因及治疗转归进行回顾性分析。结果 78例患儿中先天性CAVB患儿30例,年龄3 d～9岁,中位年龄2.2岁,3例安装永久起搏器,好转出院;2例安装临时起搏器治疗者和25例仅给予丙种球蛋白、激素、营养心肌等对症治疗者均无明显效果。后天性CAVB患儿36例,年龄1个月～14岁,中位年龄4.0岁,其中感染性心肌炎患儿19例,8例安装临时起搏器和1例安装永久起搏器者均好转出院,10例仅对症治疗者好转4例、无明显效果6例;心内直视手术及介入术后患儿15例,6例安装永久起搏器者好转出院,4例安装临时起搏器者2例好转、2例无效,5例对症治疗者均无明显效果;1例风湿性心脏病患儿,对症治疗后症状好转,心电图转为高度房室传导阻滞;1例过敏性休克患儿经对症治疗后好转,心电图无CAVB。未明确病因CAVB患儿12例,年龄5个月～11岁,中位年龄5.9岁,仅1例安装永久起搏器者好转出院,1例安装临时起搏器者和10例对症治疗者均无明显好转。结论先天性CAVB对药物治疗无明显效果,需长期临床随访,后天性CAVB药物可有显著疗效,药物治疗无效时应适时安装起搏器。

Objective To analyze clinical characteristics, treatments and outcomes of complete atrioventficular block （CAVB） in children. Methods Clinical records of 78 children with CVAB who were admitted from 2007 to 2015 at Beijing Children＇s Hospital, Capital Medical University were retrospectively analyzed. Results Thirty children had congenital CAVB; the median age was 2. 2 years （3 d-9 years） ; 3 of them had permanent pacemaker implantation land recovered well; temporary pacemaker in 2 cases and symptomatic drug therapy （gamma globulin, hormone and cardiac muscle nutritional drugs ） in 25 cases showed no positive effect. Thirty-six children had acquired CAVB; the median age was 4.0 years（ 1 months-14 years） ; among 19 infectious myocarditis, 8 cases with temporary pacemaker implantation and-1 case with permanent pacemaker implantation recovered, 4 in 10 cases with drug therapy recovered; .15 children developed CAVB after surgery or interventional procedure, 6 of them treated by permanent pacemaker implantation and 2 in 4 cases treated by permanent pacemaker implantation recovered, 5 cases treated by drug therapy showed no obvious improvement; 1 child with rheumatic heart disease and 1 child with anaphylactic shock were improved by drug therapy. Twelve children were not defined the cause of CAVB ; the median age was 5.9 years（5 months-ll years） ; 1 case with permanent pacemaker recovered; 1 ease with temporary pacemaker and 10 cases treated by symptomatic drug therapy showed no improvement. Conclusion Drug therapy has no obvious effect on congenital CAVB but it is effective for acquired CAVB; pacemaker implantation should be performed when drug therapy is not effective.