摘要
目的探讨静脉注射普罗帕酮转复儿童阵发性室上性心动过速(PSVT)的安全性和有效性,分析影响疗效的相关因素。方法回顾性分析2014年9月至2021年10月于清华大学第一附属医院心脏中心小儿科住院接受普罗帕酮急诊复律治疗的169例PSVT患儿的临床资料。169例患儿中,男118例,女51例,年龄(2.84±2.91)岁(14 d~13岁)。按照年龄分为≤1岁组、>1~3岁组、>3~7岁组、>7岁组。组间比较计量资料采用独立样本t检验、Mann-Whitney U检验,计数资料采用χ^(2)检验。结果169例PSVT患儿中,≤1岁65例(38.5%),>1~3岁47例(27.8%);>3~7岁40例(23.7%);>7岁17例(10.1%);24例(14.2%)合并先天性心脏病,153例(90.5%)首次就诊原因为非特异性表现。4.1%(7/169例)的患儿并心动过速性心肌病,有效复律后左心室射血分数由(44.0±4.0)%上升至(53.7±6.9)%(t=-4.700,P=0.003)。缓慢静脉注射普罗帕酮总体显著有效率为74.0%(125/169例)。比较不同用药次数的显著有效率,总体(多次)静脉注射显著有效率[74.0%(125/169例)]明显高于首次静脉注射显著有效率[53.3%(90/169例)],差异有统计学意义(χ^(2)=15.657,P<0.001)。比较不同年龄组显著有效率,≤1岁患儿组(60.0%,39/65例)明显低于>1岁组(82.7%,86/104例),差异有统计学意义(χ^(2)=10.696,P=0.001)。比较不同剂量组(1.5 mg/kg及1.0 mg/kg),≤1岁时,1.5 mg/kg组显著有效率(51.1%,23/45例)明显高于1.0 mg/kg组(20.0%,4/20例)(χ^(2)=5.519,P=0.019);>1岁时,2种不同剂量组显著有效率比较差异无统计学意义(57.9%比62.1%,χ^(2)=0.180,P=0.671)。静脉注射普罗帕酮不良反应率为9.5%(16/169例),其中1例表现为严重低血压,发生于伴右心功能不全的三尖瓣下移畸形患儿;15例发生心脏传导异常,均短时间内自行恢复。伴心功能轻中度损伤患儿未发生心功能恶化。结论静脉注射普罗帕酮复律儿童PSVT相对安全有效,显著有效率为74.0%,其复律成功率与年龄、剂量及用药次数相关。静脉注射普罗帕酮复律不良反应发生率虽低,但在心功能明显受损或心动过速持续无休止心功能损伤程度不明时应避免选用,警惕心功能恶化。
Objective To explore the safety and efficacy of Propafenone in terminating paroxysmal supraventricular tachycardia(PSVT)in children and analyze the factors influencing the effectiveness.Methods A retrospective study was conducted on 169 PSVT children treated with Propafenone in the Department of Pediatric Cardiology,Heart Center,the First Hospital of Tsinghua University from September 2014 to October 2021.There were 118 boys and 51 girls with an average age of(2.84±2.91)years(age range:14 days-13 years).According to age,they were divided into≤1-year-old group,>1-3-year-old group,>3-7-year-old group,and>7-year-old group.Mea-surement data were compared between groups using t-test and Mann-Whitney U test.Counting data were analyzed byχ^(2) test.Results Among the 169 children with PSVT,65 cases(38.5%)were below 1 year old,47 cases(27.8%)were>1-3 years old,40 cases(23.7%)were>3-7 years old,17 cases(10.1%)were above 7 years old.About 24 cases(14.2%)were combined with congenital heart disease.A total of 153 cases(90.5%)had nonspecific symptoms at the first visit.A total of 4.1%(7/169 cases)were complicated with tachycardia-induced cardiomyopathy,and their left ventricular ejection fraction increased from(44.0±4.0)%to(53.7±6.9)%after successful control of PSVT(t=-4.700,P=0.003).The complete termination of PSVT by intravenous Propafenone was achieved in 125 of 169 cases(74.0%,125/169 cases).The complete termination rate after multiple times of administration(74.0%)was significantly higher than that after the first intravenous injection(53.3%,90/169 cases)(χ^(2)=15.657,P<0.001).There was a significant difference regarding the complete termination rate between children≤1 year old(60.0%,39/65 cases)and those>1 year old(82.7%,86/104 cases)(χ^(2)=10.696,P=0.001).For children≤1 year old,1.5 mg/kg Propafenone(51.1%,23/45 cases)showed better efficacy for PSVT termination than 1.0 mg/kg Propafenone(20.0%,4/20 cases)(χ^(2)=5.519,P=0.019).For children>1 year old,there was no significant diffe-rence between 1.5 mg/kg and 1.0 mg/kg Propafenone groups(57.9%vs.62.1%)(χ^(2)=0.180,P=0.671).The adverse reaction rate of intravenous Propafenone was 9.5%(16/169 cases).One case presented with severe hypotension,which occurred in a child with right cardiac insufficiency with tricuspid valve depression;15 cases showed abnormal cardiac conduction and recovered spontaneously in a short time.There was no deterioration of cardiac function in children with mildly to moderately reduced cardiac function.Conclusions It is relatively safe and effective to terminate PSVT in children with intravenous Propafenone.The complete termination rate is 74.0%,which is related to age,dose and times of administration.Despite of low incidence of side effects,Propafenone should not be used to treat PSVT with cardiac function which is significantly impaired or unclear secondary to persistent tachycardia.Special attention should be paid to cardiac function deterioration in these patients.
作者
李梅婷
江河
张仪
李璟昊
周挥茗
李小梅
Li Meiting;Jiang He;Zhang Yi;Li Jinghao;Zhou Huiming;Li Xiaomei(Department of Pediatric Cardiology,Heart Center,the First Hospital of Tsinghua University(Beijing Huaxin Hospital),Beijing 100016,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2022年第22期1736-1740,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
首都临床特色应用研究(Z181100001718207)
吴阶平医学基金会临床科研专项资助基金(320.6750.18502)。
关键词
阵发性室上性心动过速
普罗帕酮
静脉注射药
儿童
婴儿
Paroxysmal supraventricular tachycardia
Propafenone
Intravenous injection
Child
Infant
作者简介
通信作者:李小梅,Email:li-xiaomei@mail.tsinghua.edu.cn。
