临时起搏在儿童缓慢心律失常中的应用分析

Application analysis of temporary pacing for children with bradyarrhythmia

目的探讨临时起搏治疗儿童缓慢心律失常的作用和效果。方法回顾性分析重庆医科大学附属儿童医院2007年6月至2018年5月收治的55例接受临时起搏治疗的缓慢心律失常患儿的临床资料,并对其临床特点及疗效进行总结和统计学分析。结果 55例缓慢心律失常包括心肌炎所致的严重房室传导阻滞(AVB)、窦性心动过缓或心搏停止29例,心肌病所致的Ⅲ°AVB或病窦综合征5例,先天性心脏病术后Ⅲ°AVB6例,先天性Ⅲ°AVB5例,Ⅲ°AVB围手术期临时起搏10例;其中39例可进行临时起搏前后阿-斯综合征发作频数比较(P=0.003),34例可进行射血分数及左室缩短率比较(P=0.000,P=0.001),26例可行左室舒张末期内径比较(P=0.001),差异均有统计学意义。经药物及临时起搏等治疗,18例临床治愈,36例好转,1例死亡,其中45%心律好转或恢复正常,10例围术期患儿均顺利度过手术麻醉期。Kruskal-Wallis H(K)检验结果显示,不同心血管基础疾病的临床及心律预后不完全相同(P=0.001,P=0.000);Mann-Whitney U检验提示心肌炎组预后较好(P=0.001,P=0.000)。结论临时起搏治疗有利于改善各种病因所致缓慢心律失常的临床症状,促进早期可逆的传导系统损伤恢复,降低Ⅲ°AVB围手术期风险,是一项安全、有效的预防和急救技术。

Objective To explore the effects and results of temporary cardiac pacing in children with bradyarrhythmia.Methods The clinical data of 55 children with bradyarrhythmia who received temporary cardiac pacing between June2007 and May 2018 in Children’s Hospital of Chongqing Medical University were analyzed retrospectively. The clinical characteristics and curative effects were summarized and statistically analyzed. Results A total of 55 cases of bradyarrhythmia included 29 cases of severe atrioventricular block(AVB),sinus bradycardia or cardiac arrest caused by myocarditis,5 cases of Ⅲ°AVB or sick sinus syndrome caused by cardiomyopathy,6 cases of Ⅲ°AVB caused by congenital heart disease after surgery,5 cases of congenital Ⅲ°AVB,and 10 cases of perioperative temporary pacing Ⅲ°AVB.Among them,39 cases were compared in Adams-Stokes syndrome(P=0.003),34 cases were compared in ejection fraction and fractional shortening(P=0.000,P=0.001),and 26 patients were compared in left ventricular end diastolic diameter(P=0.001)before and after temporary pacing,and there were statistically differences. After treatment,18 cases were clinically cured,36 cases were improved,and 1 case died,among which 45% arrhythmia were improved or recovered,and 10 cases of perioperative children all passed through the anesthesia period. Kruskal-Wallis H(K)test showed that the clinical and arrhythmia prognosis of different basic cardiovascular diseases were not completely the same(P=0.001,P=0.000);Mann-Whitney U test indicated a better prognosis in the myocarditis group(P=0.001,P=0.000).Conclusion Temporary cardiac pacing can effectively relieve the clinical symptoms of severe bradyarrhythmia caused by various etiologies,promote the recovery of acute conduction system injury,and reduce Ⅲ°AVB perioperative risk.Temporary cardiac pacing is a safe and effective prevention and first-aid technique.