2022 年第 7 期 第 17 卷

新生儿非良性心律失常的病因及临床特点分析

Etiology and clinical characteristics of neonatal non benign arrhythmia 

作者：吴海月杨曦苏瑛王继秋刘桂英

英文作者：Wu Haiyue Yang Xi Su Ying Wang Jiqiu Liu Guiying

单位：首都医科大学附属北京安贞医院儿科，北京100029

英文单位：Department of Pediatrics Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：非良性心律失常；新生儿疾病；感染

英文关键词：Nonbenignarrhythmia;Neonataldiseases;Infection

• 摘要：

• 目的 探讨新生儿发生非良性心律失常的病因及临床特点。方法 选取2016年1月至2019年12月在首都医科大学附属北京安贞医院住院的具有心律失常诊断的新生儿进行回顾性分析，依据新生儿心律失常临床分类分为非良性心律失常组和良性心律失常组。分析新生儿非良性心律失常的病因、临床特点、治疗及预后。结果 本研究纳入非良性心律失常组24例，良性心律失常组111例。良性心律失常组胎龄长于、出生体质量大于、住院天数短于非良性心律失常组（均P＜0.05）。非良性心律失常组24例患儿均存在重症感染。非良性心律失常组24例均有阵发性室上性心动过速，18例存在房室传导阻滞，同时表现为3种以上心律失常6例（25.0%），表现为快慢心律失常交替出现18例（75.0%）。非良性心律失常患儿均给予青霉素联合头孢菌素抗感染10～14 d，18例应用静脉注射用丙种球蛋白和地塞米松治疗，16例患儿予美托洛尔治疗，后2例改用普罗帕酮治疗。非良性心律失常组患儿随访至2020年12月未见非良性心律失常复发。结论 新生儿非良性心律失常以快慢心律失常同时或交替出现多见，感染是发病的诱因，快慢心律失常同时或交替出现时以治疗原发病为主，慎重选择抗心律失常药物。经过积极治疗其预后与良性心律失常无明显差异。

• Objective To explore the etiology and clinical characteristics of non benign arrhythmia in newborns. Methods Newborns with arrhythmia admitted to Beijing Anzhen Hospital, Capital Medical University from January 2016 to December 2019 were retrospective analyzed. The cases were assigned into non benign arrhythmia group and benign arrhythmia group according to clinical arrhythmia typing. The etiology, clinical characteristics, therapy and prognosis of newborns with non benign arrhythmia were analyzed. Results This study included 24 cases in non benign arrhythmia group and 111 cases in benign arrhythmia group. The gestational age, birth weight and length of stay in benign arrhythmia group were longer/higher/shorter than those in non benign arrhythmia group (all P＜0.05). Twenty-four cases in non benign arrhythmia group had severe infection. All of them had paroxysmal supraventricular tachycardia, 18 cases had atrioventricular block, 6 cases (25.0%) showed more than 3 kinds of arrhythmias, and 18 cases (75.0%) showed alternating fast and slow arrhythmias. Children with non benign arrhythmias were given penicillin combined with cephalosporin for 10-14 d. Eighteen cases were treated with intravenous immunoglobulin and dexamethasone. Sixteen cases were treated with metoprolol, and another 2 cases were treated with propafenone. The children in the non benign arrhythmia group were followed-up to December 2020, and there was no recurrence of non benign arrhythmia. Conclusions Non benign arrhythmias in neonates are more common with simultaneous or alternating fast and slow arrhythmias. Infection is a trigger for the development of the disease. When slow and fast arrhythmias occur simultaneously or alternately, treatment of the primary cause should be the main focus, and anti-arrhythmic drugs should be carefully selected. The prognosis is not significantly different from that of benign arrhythmias after active treatment.