婴幼儿快速性心律失常治疗进展

Progress on treatment of tachyarrhythmia in infants

婴幼儿快速性心律失常是危重症,以室上性心动过速和室性心动过速为主,其治疗方法与年长儿差异较大,目前缺乏相关指南。对于药物治疗,室上性心动过速及房扑的急性期以静脉注射腺苷为主,地高辛在新生儿中应用较多;预防性治疗普萘洛尔为首选,新药兰地洛尔处于开发阶段;室性心动过速可自发消退,以静脉注射利多卡因为主。对于非药物治疗,心脏电复律用于严重快速性心律失常的急救处理,射频消融用于病情较重以及药物无法控制心动过速发作的患儿,埋藏式心律转复除颤器可有效预防婴幼儿离子通道病伴有恶性室性心动过速的心源性猝死,新技术皮下植入在婴幼儿中可能优于静脉植入。

Infant tachycardia is a critical disease,mainly with supraventricular tachycardia and ventricular tachycardia.The treatment of tachycardia in infant is quite different from that of older children,and there is no relevant guidelines at present.Drug therapy in the acute stage of supraventricular tachycardia and atrial fluttery is mainly intravenous adenosine injection.Digoxin is widely used in neonates.Propranolol is the first choice for prophylactic treatment,and landilolol is in the development stage.Ventricular tachycardia can be spontaneously subsided,the treatment is dominated by intravenous lidocaine.For non-drug therapy,heart cardioerter is the emergency treatment for serious rapid arrhythmia.Radiofrequency ablation is used in infants with more severe conditions and where the onset of tachycardia can not be controlled.Bury cardioverter-defibrillator is effective in preventing infant ion channel disease complicated with malignant ventricular tachycardia induced sudden cardiac death.Subcutaneous implantion of a defibrillator may be superior to intravenous implantation in infants and young children.