胎儿心律失常预后的临床随访研究

Study of clinical prognosis and related factors of different types of fetal arrhythmias

目的讨论不同类型胎儿心律失常的临床预后及相关影响因素。方法收集我院2015年4月至2019年4月确诊的胎儿心律失常病例共46例,采用回顾性分析法,对胎儿心律失常的类型、发现孕周、分娩孕周、出生体重、母体情况、分娩方式及胎儿远期随诊临床结局进行总结及分析。结果随访46例胎儿心律失常病例,结果显示39例胎儿心律失常在分娩前或出生后恢复正常心率,预后良好。2例产前超声心动图提示胎儿有较严重的结构异常,胎儿心电图提示严重心律不齐,终止妊娠;5例胎儿存在心脏部分结构、功能异常,分娩后存活,但至随访结束时均预后不良。Cox多因素分析提示,分娩孕周越小、胎儿出生体重越低以及合并心脏器质性疾病是胎儿心律失常预后不良的危险因素,P<0.05。结论①大多数未合并严重心脏结构异常的心律失常胎儿多预后良好;②分娩孕周、出生体重和有无合并器质性疾病是胎儿心律失常临床预后的影响因素。

Objective To discuss the clinical prognosis and related factors of different types of fetal arrhythmias.Methods A total of 46 cases of fetal arrhythmia diagnosed in our hospital from April 2015 to July 2019 were collected. Retrospective analysis was used to summarize and analyze the type of fetal arrhythmia, the discovery gestational week, delivery gestational week, birth weight, and maternal status, delivery methods and long-term follow-up clinical outcomes of fetuses.Results Totally 46 cases of fetal arrhythmia were followed up. The results showed that 39 cases of fetal arrhythmia returned to normal heart rate before delivery or after birth, and the prognosis was good. Two cases which prenatal echocardiography showed severe structural abnormalities in the fetus, fetal ECG showed severe heart rate irregularities, terminated the pregnancy;5 cases of fetuses survived, but there were structural and functional abnormalities in the heart and the prognosis was poor. Cox multivariate analysis suggested that the smaller the gestational age of childbirth, the lower the fetal birth weight, and the combined organic disease were the risk factors for poor prognosis of fetal arrhythmia, P<0.05.Conclusion ①Most arrhythmic fetuses without severe cardiac structural abnormalities have a good prognosis;②Gestational gestation, birth weight and the presence or absence of organic diseases are the influencing factors of clinical prognosis of fetal arrhythmia.