本文選題：房性心動(dòng)過(guò)速 + 兒童　； 參考：《清華大學(xué)》2015年博士論文

【摘要】：房性心動(dòng)過(guò)速(房速)為兒童常見(jiàn)室上性心動(dòng)過(guò)速的一種,可見(jiàn)于各年齡組兒童,尤其嬰兒中很常見(jiàn),多表現(xiàn)為持續(xù)無(wú)休止性。頻繁或持續(xù)的心動(dòng)過(guò)速發(fā)作易導(dǎo)致心動(dòng)過(guò)速性心肌病,嚴(yán)重出現(xiàn)猝死。由于兒童血管徑小、射頻消融操作難度大等原因,兒童房速治療首選抗心律失常藥物,但目前關(guān)于房速藥物治療缺乏規(guī)范統(tǒng)一的公認(rèn)指南,只有少數(shù)小樣本回顧性的兒童藥物治療研究,治療有效率僅54%~75%。本課題分析2009年1月至2014年4月本院住院接受治療的房速患兒144例,對(duì)患兒進(jìn)行隨訪,每1~2月行動(dòng)態(tài)心電圖檢查,酌情評(píng)估心功能。詳細(xì)記錄患兒的臨床表現(xiàn)、房速特點(diǎn)、抗心律失常藥物治療效果,以血清NT-proBNP、超聲心動(dòng)圖及組織多普勒評(píng)估心功能。對(duì)兒童房速進(jìn)行臨床特點(diǎn)、抗心律失常藥物治療效果影響因素、致心動(dòng)過(guò)速性心肌病高危因素、早期心功能損害識(shí)別的研究。結(jié)果發(fā)現(xiàn),兒童房速起病年齡呈正偏態(tài)分布,3歲以內(nèi)達(dá)54.9%,臨床癥狀不典型,持續(xù)無(wú)休止性發(fā)作類型高達(dá)36.1%。以索他洛爾聯(lián)合普羅帕酮方案為主的抗心律失常藥物治療房速,總體有效率為88.7%。藥物治療效果不佳者,射頻消融即刻成功率為91.8%,射頻復(fù)發(fā)者多源于心耳位置。首次診斷年齡、發(fā)作類型、病程、索他洛爾對(duì)兒童房速抗心律失常藥物治療效果的影響有統(tǒng)計(jì)學(xué)意義。兒童房速心動(dòng)過(guò)速性心肌病發(fā)生率為18.1%,持續(xù)無(wú)休止發(fā)作患兒心肌病發(fā)病率(46.1%)顯著高于短陣性發(fā)作患兒心肌病發(fā)病率(2.6%)。心律失�？刂坪�,左室射血分?jǐn)?shù)在25±25(2~94)d恢復(fù)正常。相比左室射血分?jǐn)?shù),TDI-MPI和E/E′與異常升高的血清NT-proBNP有顯著相關(guān)性。在左室射血分?jǐn)?shù)基礎(chǔ)上,聯(lián)合間隔E/E′及側(cè)壁TDI-MPI診斷異常升高NT-proBNP,敏感率為91.7%。因此,本研究認(rèn)為:(1)兒童房速發(fā)病年齡早,臨床癥狀不典型,漏診風(fēng)險(xiǎn)高,持續(xù)無(wú)休止性發(fā)作多(36.1%)。(2)索他洛爾聯(lián)合普羅帕酮的方案治療兒童房速療效理想。(3)首次診斷年齡小,病程短,短陣發(fā)作的患兒抗心律失常藥物治療效果好。年長(zhǎng)、持續(xù)無(wú)休止性發(fā)作房速患兒,抗心律失常藥物治療效果欠理想,推薦射頻消融治療。(4)兒童房速心動(dòng)過(guò)速性心肌病發(fā)病率為18.1%,持續(xù)無(wú)休止性發(fā)作是關(guān)鍵高危因素。(5)相比左室射血分?jǐn)?shù),組織多普勒參數(shù)E/E′、TDI-MPI對(duì)早期心功能損害的識(shí)別有更好的應(yīng)用前景。本文國(guó)內(nèi)首次大樣本對(duì)兒童房速臨床特點(diǎn)、藥物治療及致心功能損害進(jìn)行長(zhǎng)期隨訪和全面分析,研究結(jié)果對(duì)制定兒童房速的臨床診治方案有較好的參考價(jià)值。
[Abstract]:Atrial tachycardia (atrial tachycardia) is one of the most common supraventricular tachycardia in children. Frequent or sustained tachycardia attacks may lead to tachycardia cardiomyopathy, severe sudden death. Because of the small diameter of children's blood vessels and the difficulty of radiofrequency ablation, children's atrial tachycardia therapy is the first choice of antiarrhythmic drugs, but at present there is a lack of standardized and uniform guidelines for the treatment of atrial tachycardia drugs. Only a small sample of retrospective child drug therapy studies, the effective rate of treatment is only 54 / 7575. From January 2009 to April 2014, 144 hospitalized patients with atrial velocity were analyzed. The patients were followed up, and ambulatory electrocardiogram was performed every 1 ~ 2 months to evaluate cardiac function. The clinical manifestations, atrial tachycardia, antiarrhythmic effect, serum NT-proBNPs, echocardiography and tissue Doppler were used to evaluate cardiac function. The clinical characteristics of children with atrial tachycardia, the influencing factors of antiarrhythmic drug therapy, the risk factors of cardiomyopathy, and the recognition of early cardiac function damage were studied. The results showed that the age of children with rapid onset was positively skewed to 54.9 years old, the clinical symptoms were atypical, and the type of persistent restless attack was as high as 36.1%. The total effective rate of atrial tachycardia treated with sotalol combined with propafenone was 88. 7%. The immediate success rate of radiofrequency ablation was 91.8 for the patients with poor drug therapy, and most of the patients with radiofrequency recurrence originated from the auricular position. The effect of sotalol on the efficacy of antiarrhythmic drugs in children's atrial tachycardia was statistically significant in the first diagnosis of age, type of attack, course of disease. The incidence of cardiomyopathy in children with atrial tachycardia was 18.1.The incidence of cardiomyopathy in children with persistent restless attack was significantly higher than that in children with short duration attack (46.1%). After arrhythmia control, left ventricular ejection fraction (LVEF) returned to normal at 25 鹵25 d. Compared with left ventricular ejection fraction (LVEF), TDI-MPI and E / E 'were significantly correlated with elevated serum NT-proBNP. On the basis of left ventricular ejection fraction (LVEF) combined with septal E / E 'and lateral wall TDI-MPI the diagnosis of NT-proBNPs was abnormal and the sensitivity rate was 91.7%. Therefore, this study suggests that the children's atrial tachycardia onset age is early, the clinical symptoms are atypical, the risk of missed diagnosis is high, the duration of restless seizures is much more than 36.1%, and the therapeutic effect of sotalol combined with propafenone is ideal. 3) the first diagnosis age is young. The short course of disease, short-array attack of children with anti-arrhythmia drug treatment effect is good. The effect of antiarrhythmic drugs on atrial tachycardia was not satisfactory in the elderly and children with persistent restless atrial tachycardia. Recommended radiofrequency catheter ablation (RFA). 4) the incidence of tachycardia cardiomyopathy in children is 18.1.The persistent restless attack is the key risk factor. 5) compared with left ventricular ejection fraction (LVEF). TDI-MPI has a better application prospect in the recognition of early cardiac function damage. For the first time in China, a large sample of children was followed up and comprehensively analyzed for the clinical characteristics, drug therapy and cardiac function damage. The results of the study have a good reference value for the clinical diagnosis and treatment of children's atrial velocity.
【學(xué)位授予單位】：清華大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R725.4

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