摘要
目的研究胎儿期心律失常的病因、发病机制、心律失常类型、临床表现及预后。方法收集21例胎儿心律失常病例的临床资料,分析其临床特点、胎儿心律失常的类型及出生后新生儿随访结果。结果 21例孕妇的年龄(31. 1±4. 7)岁,在检出心律失常时孕(31. 5±5. 2)周,胎儿心律失常类型为房性期前收缩(房早) 14例(67%),室性期前收缩(室早)、心房扑动、心动过缓各2例(10%),心房颤动1例(5%)。对妊娠期胎儿心律失常采用期待治疗及严密监测,有明确感染源2例给予抗感染治疗,对心房颤动、心房扑动以及房早和室早并发胎儿水肿者均给予母体强心治疗,动态评估胎儿心功能,发现胎儿水肿、心力衰竭及时剖宫产终止妊娠。21例中,剖宫产9例(43%),阴道分娩9例(43%),因患SLE及抗磷脂抗体综合征要求引产2例(10%),胎死宫内1例(5%)。18例新生儿出生时,房早10例、室早2例、心房扑动1例、心房颤动1例、无异常2例。随访3个月～5年,失访1例,获得随访17例,除1例患儿出现持续心房颤动外,其余16例患儿均痊愈。结论妊娠期最常见的胎儿心律失常为房早,预后良好。妊娠期发现胎儿期心律失常可采用期待治疗,动态监测胎儿心脏功能,如发现胎儿严重心动过缓或心律失常的情况,应进行自身免疫疾病的筛查,尽早明确诊断和积极处理,避免不良围生结局。
Objective To investigate the etiology, pathogenesis, type, clinical manifestations and prognosis of fetal arrhythmia. Methods Clinical data of 21 pregnant women of fetal arrhythmia were collected. Clinical characteristics, type of fetal arrhythmia and follow-up results of the newborns were analyzed. Results The mean age of 21 pregnant women was （31.1±4.7） years. The gestational age was （31.5±5.2） weeks upon the diagnosis of arrhythmia. The types of fetal arrhythmia included premature atrial contraction in 14 cases （67%）, premature ventricular contraction in two （10%）, atrial flutter in two （10%）, bradycardia in two （10%） and atrial fibrillation in one case （5%）. Expectant treatment and intimate monitoring were performed for fetal arrhythmia during pregnancy. Two cases with definite source of infection received anti-infection treatment. Those with atrial fibrillation, atrial flutter and premature atrial and ventricular contraction complicated with fetal edema were given with maternal cardiotonic therapy. Fetal cardiac function was dynamically evaluated. Pregnancy was terminated by cesarean section immediately after the incidence of fetal edema and heart failure. Among 21 cases, 9 cases （43%） underwent cesarean section and 9 （43%） received vaginal delivery. Two cases （10%） were subject to induced abortion due to systemic lupus erythematosus （SLE） and antiphospholipid syndrome and one （5%） experienced intraunterine fetal death. Of 18 newborns, premature atrial contraction developed in 10 cases, premature ventricular contraction in two cases, atrial flutter in one case, atrial fibrillation one case and two cases were normal. During 3-month to 5-year follow-up, one case was lost and 17 cases were followed up. Except one neonate presented with persistent atrial fibrillation, the remaining 16 cases were cured. Conclusions Premature atrial contraction is the most common type of fetal arrhythmia during pregnancy with good clinical prognosis. Expectant treatment and dynamitic monitoring of fetal cardiac function can be performed for fetal arrhythmia during pregnancy. If severe bradycardia or arrhythmia is found in the fetus, the screening of autoimmune diseases, early diagnosis and immediate treatment should be carried out to avert the incidence of adverse perinatal outcomes.
作者
苏丽荣
于洋
张龑
Su Lirong;Yu Yang;Zhang Yan(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)
出处
《新医学》
2018年第10期726-730,共5页
Journal of New Medicine
基金
国家重点研发计划"生殖健康及重大出生缺陷防控研究"重点专项(2017YFC1001404)
关键词
胎儿
心律失常
预后
Fetus
Arrhythmia
Prognosis
