三磷酸腺苷对儿童阵发性室上性心动过速急诊复律的有效性研究

Evaluation of adenosine triphosphate in emergency cardioversion of paroxysmal supraventricular tachycardia in children

目的探讨三磷酸腺苷(ATP)终止儿童阵发性室上性心动过速(PSVT)的安全性、有效性及其疗效与年龄、剂量的相关性。方法回顾性分析2014年9月至2019年11月在清华大学第一附属医院心脏中心儿科住院治疗的1488例PSVT患儿中接受ATP急诊复律的120例患儿的临床资料,以及静脉推注ATP的治疗效果、不良反应。其中男80例,女40例;年龄(3.50±3.66)岁(25 d~15岁)。组间比较计量资料采用独立样本t检验、Mann-Whitney U检验;计数资料采用χ^(2)检验。结果120例PSVT患儿中<1岁者42例(35.0%),24例(20.0%)并先天性心脏病。8.3%(10/120例)患儿继发心动过速性心肌病,有效复律后左心室射血分数(LVEF)由(32.70±11.69)%升至(40.50±11.63)%(t=-3.647,P=0.005)。静脉推注ATP总体显著有效率为44.2%(53/120例)。对比静脉推注ATP不同剂量组(0.3 mg/kg、0.2 mg/kg及0.1 mg/kg),显著有效率分别为56.5%(13/23例)、36.4%(32/88例)及0,不同剂量组间疗效比较差异有统计学意义(χ^(2)=10.058,P=0.007)。<1岁患儿组31.0%(13/42例)低于≥1岁患儿组[51.3%(40/78例)],差异有统计学意义(χ^(2)=4.575,P=0.032)。对于ATP难复性PSVT,在持续泵入抗心律失常药物仍未复律基础上再予静脉推注ATP,显著有效率达55.6%(10/18例)。ATP不良反应率为2.5%(3/120例),表现为一过性窦性停搏,发生于>1岁患儿及剂量为0.2~0.3 mg/kg时。结论儿童PSVT应用ATP复律相对安全有效,其复律成功率与剂量及年龄相关。对于ATP难复性PSVT,可在静脉持续泵入其他抗心律失常药物基础上静推ATP,可提高显著有效率。

Objective To explore the safety and efficacy of adenosine triphosphate(ATP)in terminating paro-xysmal supraventricular tachycardia(PSVT)in children and the correlation between its efficacy,age and dose.Methods A retrospective analysis was performed on the clinical data,efficacy and adverse effects of intravenous ATP in 120 children who had received ATP emergency cardioversion among 1488 children with PSVT hospitalized in the Department of Pediatric Cardiology,Heart Center,First Hospital of Tsinghua University from September 2014 to November 2019.There were 80 boys and 40 girls with the age of(3.50±3.66)years(25 d-15 years).As for the group comparison,the measurement data was subject to the independent samples t test and Mann-Whitney U test;the enumeration data was subject toχ^(2)test.Results Among the 120 children with PSVT,there were 42 cases(35.0%)<1 year old,and 24 cases(20.0%)combined with congenital heart disease.There were 8.3%of them(10/120 cases)suffering from tachycardiomyopathy(TCM)secondary to PSVT,whose LVEF increased from(32.70±11.69)%to(40.50±11.63)%after successful control of PSVT(t=-3.647,P=0.005).The complete termination of PSVT by intravenous ATP was achieved in 53 of 120 cases(44.2%).ATP was given at 0.3 mg/kg,0.2 mg/kg and 0.1 mg/kg in dose,and the significant effective rate was 56.5%(13/23 cases),36.4%(32/88 cases)and 0,respectively,which showed that there was a significant difference in the therapeutic effect between different dose groups(χ^(2)=10.058,P=0.007).There was a significant difference regarding the complete termination rate between children<1 year old and those≥1 year old[31.0%(13/42 cases)vs.51.3%(40/78 cases),χ^(2)=4.575,P=0.032].For refractory PSVT,the intravenous ATP was performed based on the absence of cardioversion with continuous pumping of other antiarrhythmic drugs,which achieved a significantly complete termination rate of 55.6%(10/18 cases).The rate of ATP adverse reactions was 2.5%(3/120 cases),presented with sinus arrest in children>1 year old with the dose of 0.2-0.3 mg/kg.Conclusions It was relatively safe and effective to terminate PSVT in children with ATP,which was related to dose and age.For refractory PSVT,ATP can be intravenously pushed on the basis of continuous pumping of other antiarrhythmic drugs,which can achieve a higher complete termination rate.