儿童重症监护病房不同年龄儿童室上性心动过速的临床分析

Clinical analysis of supraventricular tachycardia in children with different age in pediatric intensive care unit

目的分析PICU中室上性心动过速(supraventricular tachycardia,SVT)患儿的发作特点、病情严重程度和对不同抗心律失常药物的治疗反应,为临床医生提供诊治经验。方法回顾性分析2012年1月至2019年12月中国医科大学附属盛京医院PICU住院的不同年龄SVT患儿的临床特点及对不同药物的疗效观察。结果73例患儿,男53例(72.6%),女20例(27.4%);婴儿组(1个月~1岁)31例(42.5%),幼儿组(1~3岁)15例(20.5%),年长儿组(3~14岁)27例(37.0%)。首发临床表现以发现心率增快36例(49.3%)、进乳差或拒乳12例(16.4%)、心悸心前区不适11例(15.1%)、伴发热咳嗽13例(17.8%)为主;进乳差或拒乳仅发生在婴儿组,幼儿组和年长儿组发现心率增快多于婴儿组,年长儿组自觉心悸或心前区不适者比例也明显高于其他两组,组间比较差异有统计学意义(P<0.05)。并发充血性心力衰竭18例(24.7%),心源性休克6例(8.2%)。婴儿组患儿合并先天性心脏病比例和诊断充血性心力衰竭比例均显著高于幼儿组和年长儿组,组间比较差异有统计学意义(P<0.05)。药物转律成功54例(74.0%),联合同步电复律成功6例(8.2%);转律未成功5例(6.8%),死亡4例(5.5%)。结论PICU不同年龄SVT患儿的临床表现、心电图表现和心脏基础疾病不同;药物和同步电复律不能全部转律;可并发危及生命的心力衰竭或心源性休克,甚至死亡。

Objective To analyze the clinical characteristics,severity of disease and treatment response of different anti-arrhythmic drugs in children with supraventricular tachycardia(SVT)hospitalized in PICU,providing few empirical messages for pediatricians.Methods A retrospective study was conducted in children of different ages with SVT admitted to PICU at Shengjing Hospital of China Medical University from January 2012 to December 2019,collecting data regarding patients′clinical features and curative effect of different drugs.Results Among seventy-three cases,53 cases(72.6%)were male and 20 cases(27.4%)were female,including 31 infant cases(42.5%),15 toddler cases(20.5%),and 27 elderly children(37.0%).Main clinical manifestations for initially complains in sequence included:36 cases(49.3%)with findings of fast heart rate,12 cases(16.4%)with poor or rejective feeding with milk,11 cases(15.1%)with discomfort of the precordial area,and 13 cases(17.8%)with fever or cough.By comparative of the clinical manifestations of patients,poor or rejective feeding with milk was more in infants group than the other two groups,findings of fast heart rate was more in toddler and elderly groups compared with infant group,and more elderly children with discomfort of the precordial area compared with the other two groups,which showed significant differences(P<0.05).Eighteen cases(24.7%)developed to congestive heart failure and six cases(8.2%)of them diagnosed with cardiac shock.Ratio of congenital heart disease and percentile of complicated with heart failure were higher in infant group compared with the other two groups,with significant difference(P<0.05).Fifty-four cases(74.0%)were successful turnover.Six cases(8.2%)were turnover with assistance of synchronized cardioversion.Five cases(6.8%)were failed in turnover,and four cases(5.5%)died.Conclusion Children grouped with ages admitted to PICU with SVT show different clinical manifestations,variant electrocardiograms and underline diseases.Not all of SVT could successfully turnover with medications and synchronized cardioversion.Some cases would developed to life-threatening heart failure or cardiogenic shock,even death.