婴幼儿先天性心脏病术后出现交界性异位心动过速11例分析

摘要

Objective To summarize the diagnosis and therapy of junctional ectopic tachycardia(JET) in the infants after surgery for congenital heart disease under cardiopulmonary bypass(CPB).Methods JET occurred in 11 infants in 6 to 20 hours after surgery for congenital heart disease cases under CPB,which included ventricular septel defect in 4 cases,retralogy of Fallot in 5 cases, total anomalous pulmonary venous connection in one case and partial atrial ventricular septal defect in one case.The JET infants were treated with sedation,mechanical ventilation and deliberate hypothermia keeping the core body temperatue of 32 to 35℃.Cordarone(amiodarone hydrochloride) was infused to maintain heart rate below 180 beats per minute.At same time,rapid digitalization was performed and vasoactive agents were used as well.Results Sinus rhythm of all 11 cases was returned with a stable circulation after treatments mentioned above.Compared to before operation,cardiac ultrasound examination showed significant decreases of the left ventricular ejection fraction[(52.73±6.47)% vs.(68.82±1.89)%] and left ventricular fractional shortening[(26.18±2.67)% vs.(37.09±1.30)%] one week later,which returned to normal in three months.Conclusion JET in the infants after surgery for congenital heart disease affects the hemodynamics significantly.Early treatments with controlled hypothermia and cordarone can effectively lower heart rate and promote the recovery of sinus rhythm.%目的 总结婴幼儿心肺转流(CPB)先天性心脏病术后出现交界性异位心动过速(JET)的诊治体会.方法 11例先天性心脏病婴幼儿于CPB术后6~20h诊断JET.原发疾病:室间隔缺损4例,法洛四联症5例,完全性肺静脉异位连接(心内型)1例,部分型房室隔缺损1例.诊断JET后的处理:镇静、呼吸机辅助呼吸;控制性降温,采用体表降温法将直肠温度降至33~35℃;静脉输注胺碘酮,维持心率于180次/分以下;快速洋地黄化;调整血管活性药物的用量.结果 经上述处理后,11例患儿心律均转为窦性,循环稳定.术后1周复查心脏超声,左心室射血分数和左室短轴缩短率均低于术前,术后3个月恢复正常.结论 婴幼儿先天性心脏病CPB术后JET对血流动力学影响大,早期控制性降温及应用胺碘酮等处理可有效减慢心率,使心律转成窦性.