15例儿童心动过速性心肌病的临床分析

发布时间：2018-09-04 07:35

【摘要】：目的：探讨心动过速性心肌(Tachycardia-induced cardiomyopathy,TIC)的临床特点、诊断、治疗方法及预后，并与原发性扩张型心肌病(Dilated Cardiomyopathy, DCM)进行比较研究，提高认识，指导TIC的诊断治疗。方法：收集了2007年1月至2013年12月在我院住院部的374例心律失常及53例原发性扩张型心肌病，其中15例符合心动过速性心肌病，24例符合扩张型心肌病合并心动过速，针对两组患儿一般资料、临床表现、心功能、胸片、心电图或24小时动态心电图、超声心动图、治疗、疗效及预后等进行回顾性分析及对比。结果：TIC组和DCM组年龄分别是2.7±3.3岁，7.9±4.0岁，两组比较差异有统计学意义(t=4.47，P0.01)；两组患儿性别、初次入院时病程、改良Ross评分及首次住院治疗时间差异均无统计学意义(P0.05)；两组临床表现大致相仿，，均可出现气促、活动后心累乏力、多汗、心悸胸闷、面色苍白、头晕等，大部分患儿均出现了咳嗽、发热、呕吐、腹痛等心脏外不适症状，大多有肝脏肿大、心律不齐、心音低钝、心脏杂音等体征；两组入院时心室率分别是189±26.4次/分、135.4±35.8次/分，两组比较差异有统计学意义(t=5.97，P0.01)；TIC组以房性心动过速为主(8例，53.3%)，而DCM组以窦性心动过速伴频发室性早搏或房性早搏为主(10例、41.6%)；住院治疗前TIC组LVEF、LVFS均明显高于DCM组，TIC组LVEDD值明显小于DCM组(P0.05)，差异均有统计学意义；住院治疗后两组心率、改良Ross评分、LVEF、LVFS均较治疗前明显改善(P0.05)，差异有统计学意义，LVEDD较治疗前降低不明显(P0.05)，差异无统计学意义。出院后随访发现：TIC组14例(100%)患儿心功能恢复正常，10例(71.4%)心脏扩大恢复正常，无1例死亡；而DCM组中有7例失访，随访的17例中7例(41.2%)死亡，余下10例中3例(30.0%)心功能恢复正常，10例(100%)左室仍有明显扩大，两组差异均具有统计学意义(P0.05)。结论：小儿TIC与DCM在临床表现、心脏彩超、胸片及心电图特征方面有很多相似之处，容易混淆，有时鉴别比较困难。对于同时存在心动过速、心功能不全及心脏扩大的患儿，需考虑TIC，但同时必须注意与DCM鉴别诊断。TIC一般起病较急，心律失常多以频繁或持续房性心动过速为主，治疗前心功能下降及心脏扩大程度均不及DCM，给予有效复律、控制心室率及心衰等治疗后心功能可部分甚至完全恢复正常，预后明显优于DCM。
[Abstract]:Objective: to investigate the clinical features, diagnosis, treatment and prognosis of cardiac tachycardia (Tachycardia-induced cardiomyopathy,TIC), and compare it with (Dilated Cardiomyopathy, DCM) of primary dilated cardiomyopathy to improve the understanding and guide the diagnosis and treatment of TIC. Methods: 374 cases of arrhythmia and 53 cases of primary dilated cardiomyopathy were collected from January 2007 to December 2013 in our hospital. Among them, 15 cases were in accordance with tachycardia cardiomyopathy and 24 cases were in accordance with dilated cardiomyopathy with tachycardia. The general data, clinical manifestations, cardiac function, chest radiographs, electrocardiogram (ECG) or 24 hour ambulatory electrocardiogram (ECG), echocardiography, treatment, curative effect and prognosis were retrospectively analyzed and compared between the two groups. Results the age of the two groups was 2.7 卤3.3 years old and 7.9 卤4.0 years old, respectively. There was significant difference between the two groups (t = 4.47, P 0.01), but there was no significant difference in the sex, the course of disease, the modified Ross score and the first hospitalization time between the two groups (P0.05). The clinical manifestations of the two groups were similar. They all showed shortness of breath, fatigue, sweating, palpitations, paleness, dizziness, and so on. Most of the children had symptoms of cough, fever, vomiting, abdominal pain, etc. The heart rate of the two groups was 189 卤26.4 times / min 135.4 卤35.8 times / min respectively, and the difference between the two groups was statistically significant (t = 5.97, P0.01). In TIC group, atrial tachycardia was predominant (8 cases, 53.3%), while in DCM group, sinus tachycardia accompanied with frequent ventricular premature beat or atrial premature beat was the main factor (10 cases, 41.6%). Before hospitalization, LVEF,LVFS in TIC group was significantly higher than that in DCM group (P0.05), and the difference was statistically significant. The improved Ross scores were significantly improved compared with those before treatment (P0.05), and the difference was not significant (P0.05). After discharge, 14 (100%) children in the DCM group were found to have normal cardiac function and 10 (71.4%) had normal cardiac function, while 7 cases (41.2%) in the DCM group had lost their visit and 7 cases (41.2%) had died. Of the remaining 10 cases, 3 cases (30.0%) had normal cardiac function and 10 cases (100%) had significant left ventricular enlargement. The difference between the two groups was statistically significant (P0.05). Conclusion: there are many similarities between TIC and DCM in clinical manifestations, echocardiography, chest radiography and electrocardiogram, which are easy to be confused and sometimes difficult to distinguish. For the children with tachycardia, cardiac insufficiency and cardiac enlargement, we should consider TIC, but at the same time, we must pay attention to the differential diagnosis of DCM. TIC is usually acute, and arrhythmias are mainly frequent or persistent atrial tachycardia. Before treatment, the decrease of cardiac function and the degree of cardiac enlargement were not as good as those given by DCM,. After the treatment of controlling ventricular rate and heart failure, the cardiac function could return to normal in part or even completely, and the prognosis was obviously better than that of DCM..
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.4

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