不同刺激方式诱发儿童快速型心律失常效果的对比分析

Comparative Analysis of the Effects of Different Stimulation Methods on Children With Tachyarrhythmia

目的探讨经食管心房调搏何种诱发刺激方式更适合儿童患者。方法选取南方医科大学附属中山市博爱医院在2013年1月1日—2021年4月30日收治的71例心电图提示PSVT或因心动过速病史就诊的患儿作为研究对象。随机分成观察组和对照组,其中观察组41例,对照组30例。各组病例均在经食管心房调搏检查中采用不同的刺激方式进行诱发。观察组应用S1S2程控刺激法、对照组应用RS2程控刺激法。分析两组诱发心动过速的成功率、首次诱发成功时间、不良反应发生率等,对比不同刺激方式诱发的效果。结果观察组成功率(85.37%)明显高于对照组(70.00%)。首次诱发成功时间为(12.71±2.36)min,明显短于对照组的(19.31±3.02)min,比较差异有统计学意义(P<0.05)。观察组有38例(92.68%)出现胸胸骨后灼痛、心悸、精神紧张、哭闹抗拒检查等不良反应,对照组有17例(56.67%)出现上述不良反应,比较差异有统计学意义(P<0.05)。观察组不良反应不耐受程度轻于对照组,比较差异有统计学意义(P<0.05)。观察组诱发心动过速成功率(70.10%)明显高于对照组(42.06%),比较差异有统计学意义(P<0.05)。71例患者中,有56例恢复窦性心律(53例被Burst猝发刺激或S1S1超速抑制终止,恢复窦性心律;2例终止后反复发作,予药物治疗后恢复窦性心律;1例无法终止,予药物治疗后终止恢复窦性心律);余者15例行心内电生理检查,符合率86.67%。结论对于儿童患者的经食管心房调搏检查刺激方式的选择推荐首选S1S2程控刺激法,可得到更高的诱发成功率,更快完成检查,若检查项目较多或需采集的数据较多,可结合RS2刺激法,减少不良反应的发生。

Objective To explore which kind of stimulation of transesophageal atrial pacing is more suitable for children patients.Methods A total of 71 chidren with a history of tachycardia or PSVT were enrolled from January 1,2013 to April 30,2021 in the Southern Medical University of Zhongshan Bo’ai Hospital.The patients were randomly divided into two groups:the observation group(41 cases)and the control group(30 cases).All the patients in each group were induced by different stimulation methods in transesophageal atrial pacing.S1S2 programmed stimulus method was used in the observation group and RS2 programmed stimulus method was used in the control group.The success rate of tachycardia,the time of first induction,the rate of adverse reaction and so on were analyzed.Results The observed composition power(85.37%)was significantly higher than that of the control group(70.00%).The first successful induction time was(12.71±2.36)min,which was significantly shorter than that of the control group(19.31±3.02)min,and the difference was statistically significant(P<0.05).In the observation group,38 cases(92.68%)had adverse reactions such as retrosternal burning pain,palpitations,nervousness,crying and resisting examination,and 17 cases(56.67%)in the control group had the above adverse reactions,and the difference was statistically significant(P<0.05).The degree of adverse reaction intolerance in the observation group was lighter than that in the control group,and the difference was statistically significant(P<0.05).The success rate of induced tachycardia in the observation group(70.10%)was significantly higher than that in the control group(42.06%).The difference was statistically significant(P<0.05).Among the 71 patients,56 cases recovered sinus rhythm(53 cases were terminated by burst stimulation or S1S1 overspeed inhibition to recover sinus rhythm;2 cases recurred after termination and recovered sinus rhythm after drug treatment;1 case could not be terminated and terminated sinus rhythm after drug treatment).The remaining 15 cases underwent intracardiac electrophysiological examination,and the coincidence rate was 86.67%.Conclusion S1S2 program-controlled stimulation is recommended as the first choice for children with transesophageal atrial pacing,which can achieve a higher success rate of induction and complete the examination more quickly if more items are needed or more data need to be collected,RS2 stimulation can be combined to reduce the occurrence of adverse reactions.