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目的分析体重<10 kg行心内直视手术后早期发生心律失常婴幼儿的临床特点,探讨其防治措施。方法回顾性分析2007年6月~2009年6月第三军医大学附属新桥医院收治的88例体重<10 kg行心内直视手术后早期发生心律失常婴幼儿患者的临床资料,其中男49例,女39例;年龄1.0个月~2.5岁(12.4±5.5个月);体重2.5~9.7 kg(6.4±2.8 kg)。术后对发生窦性心动过速和室上性心动过速患者给予对症处理,如无效,给予西地兰或普罗帕酮或胺碘酮治疗;对Ⅱ°和Ⅲ°房室传导阻滞合并心率缓慢患者,给予异丙肾上腺素、激素,临时/永久心脏起搏器;对室性心律失常患者给予利多卡因或胺碘酮治疗。结果围术期共死亡4例,病死率4.5%。死于低心排血量综合征2例,多器官功能衰竭1例,室性心动过速1例。术后发生窦性心动过速58例,室上性心动过速18例(心率200~300次/分);房室传导阻滞6例(Ⅰ°1例、Ⅱ°4例、Ⅲ°1例);室性心律失常6例;均经给予对症处理、抗心律失常药物或安置临时/永久心脏起搏器治疗好转或治愈。随访76例,随访时间6~40个月(20.4±11.5个月),所有患者健康状况良好,无严重心律失常发生。失访8例。结论体重<10 kg的婴幼儿行心内直视手术后早期心律失常发生率高,应加强监护,慎重选择抗心律失常药物;复杂型心内畸形,体重<6 kg、年龄<6个月的婴幼儿术后早期更易出现室性心律失常,应加强防治。
Objective To analyze the clinical features of infants and young children with early arrhythmia after open heart surgery with body weight <10 kg, and to explore their preventive and therapeutic measures. Methods The clinical data of 88 infants and young children with arrhythmia who had body weight <10 kg underwent open heart surgery after cardiac surgery were retrospectively analyzed from June 2007 to June 2009 in Xinqiao Hospital, Third Military Medical University. Among them, male 49 Cases, female 39 cases; age 1.0 months to 2.5 years (12.4 ± 5.5 months); weight 2.5 ~ 9.7 kg (6.4 ± 2.8 kg). Patients with sinus tachycardia and supraventricular tachycardia were given symptomatic treatment, if not, given cedilan or propafenone or amiodarone treatment; Ⅱ ° and Ⅲ ° atrioventricular block heart rate Slow patients, given isoproterenol, hormones, temporary / permanent pacemaker; patients with ventricular arrhythmias lidocaine or amiodarone treatment. Results Perioperative total death in 4 cases, the mortality rate of 4.5%. 2 died of low cardiac output syndrome, 1 case of multiple organ failure, 1 case of ventricular tachycardia. Postoperative sinus tachycardia in 58 cases, 18 cases of supraventricular tachycardia (heart rate 200 to 300 beats / min); atrioventricular block in 6 cases (Ⅰ ° 1 case, Ⅱ ° 4 cases, Ⅲ ° 1 Cases); ventricular arrhythmias in 6 cases; were given symptomatic treatment, anti-arrhythmic drugs or placement of temporary / permanent pacemaker treatment improved or cured. Sixty-six follow-up cases were followed up for 6 to 40 months (20.4 ± 11.5 months). All patients were in good health with no serious arrhythmia. Lost in 8 cases. Conclusion Infants with body weight <10 kg have a high incidence of early arrhythmia after open heart surgery. Careful monitoring should be performed to prevent antiarrhythmic drugs. Complex intracardiac malformations with body weight <6 kg and <6 months Early infants and young children are more prone to ventricular arrhythmias, prevention and treatment should be strengthened.