新生儿心律失常临床特征、治疗及预后分析

Clinical features,treatments,and outcomes of neonatal arrhythmia

目的评估新生儿心律失常的病因和治疗转归。方法回顾性分析2017年6月—2020年5月诊断为心律失常新生儿的临床资料和短期随访结果。结果纳入23例心律失常新生儿,男11例、女12例,平均胎龄(36.2±2.9)周,平均出生体重(2784.8±727.7)g,足月12例、早产11例。8例出生前即有胎心异常。异位搏动9例,心动过速12例,传导阻滞2例。心律失常病因主要为心脏结构异常、新生儿呼吸窘迫综合征、出生窒息;14例无明确病因及临床症状。12例心动过速患儿均给予药物或电复律治疗,无临床症状患儿(室上性期前收缩6例、室性期前收缩3例和房室传导阻滞1例)均未予抗心律失常治疗。死亡4例(17.4%),死亡组血清肌酸激酶、肌酸激酶同工酶、肌钙蛋白、B型钠尿肽水平显著高于存活组,差异有统计学意义(P<0.05)。19例存活至出院的患儿中,11例动态心电图仍异常,2例予口服药物维持治疗。随防至1岁时,所有患儿均未因症状性心律失常再次入院。结论心律失常既可发生于有基础疾病的新生儿,也可无明确病因及临床症状,心肌标志物升高者预后较差。快速型心律失常需尽快复律;对于无明确病因及症状、心功能良好者可不干预,但需严密随访。

Objective To evaluate the etiology,treatment and outcome of neonatal arrhythmia.Methods The clinical data and short-term follow-up results of neonates diagnosed with arrhythmia from June 2017 to May 2020 were retrospectively analyzed.Results Twenty-three cases with neonatal arrhythmia(11 boys and 12 girls)were included.The mean gestational age was(36.2±2.9)weeks and the mean birth weight was(2784.8±727.7)grams.There were 12 full-term and 11 preterm infants.Abnormal fetal heart rhythm of 8 cases were observed in the prenatal period.There were 9 cases of ectopic beats,12 cases of tachycardia and 2 cases of conduction block.The main causes of arrhythmia were cardiac structural abnormality,neonatal respiratory distress syndrome and asphyxia at birth.Fourteen cases did not have clear etiology or clinical symptoms.Twelve cases with tachycardia were treated with anti-arrhythmia drugs or electrical cardioversion,while those without clinical symptoms(6 cases of supraventricular premature beats,3 cases of ventricular premature beats and 1 case of atrioventricular block)did not receive anti-arrhythmia therapy.Four neonates died(17.4%)eventually.Serum levels of creatine kinase,creatine kinase-MB isoenzyme,cardiac troponin T and B-type natriuretic peptide in death group were significantly higher than those in survival group,and the difference was statistically significant(P<0.05).Of the 19 infants who survived until discharge,11 showed abnormal rhythm on dynamic electrocardiogram,and 2 were treated with oral anti-arrhythmia drug after discharge.By 1 year of age,none of the patients had been readmitted to the hospital for symptomatic arrhythmia.Conclusions Arrhythmia may occur in newborns with underlying diseases,or without clear cause or clinical symptoms.The prognosis of patients with elevated myocardial markers is poor.Rapid arrhythmia should be considered as soon as possible.For those without clear cause or symptoms,those with good heart function,no intervention should be involved,but need to be closely followed.