2021 年第 2 期 第 16 卷

胎儿心律失常的围产期管理和近远期结局

Perinatal management and short-term and long-term outcomes of fetal arrhythmia

作者：齐营营杨璞玉赵赫杨冬李燕娜张军

英文作者：arrhythmiaQi Yingying Yang Puyu Zhao He Yang Dong Li Yanna Zhang Jun

单位：首都医科大学附属北京安贞医院妇产科100029

英文单位：Department of Obstetrics and Gynecology Beijing Anzhen Hospital Capital Medical University Beijing 100029 ChinaQi Yingying′s original work unit was Department of Obstetrics and Gynecology of Beijing Miyun District Hospital

关键词：心律失常；胎儿；围产期管理；超声心动图

英文关键词：Arrhythmia;Fetus;Perinatalmanagement;Echocardiography 

• 摘要：

• 目的 探讨胎儿心律失常的围产期管理和近远期结局。方法 选取2010年1月至2017年12月在首都医科大学附属北京安贞医院通过胎儿超声心动图检查诊断为持续性胎儿心律失常孕妇72例，记录心律失常类型，孕妇的年龄、确诊孕周、妊娠早期疾病史、既往史、药物治疗情况，胎儿心律失常类型与胎儿水肿、心功能异常、心脏结构异常和不良结局的关系。结果 72例胎儿持续性心律失常类型中期前收缩最多，为42例（58.3%），其余分别为室上性心动过速（SVT）16例、窦性心动过缓（SB）6例，心房扑动5例，房室传导阻滞（AVB）3例。共16例患者失访，其中期前收缩11例、SVT 4例、SB 1例；其余56例随访3～5年。不同类型胎儿心律失常母体的年龄和确诊孕周比较差异均无统计学意义（均P＞0.05）。妊娠早期发热服药史21例，其中心房扑动1例、AVB 1例、期前收缩15例、SB 3例、SVT 1例，5例出现不良妊娠结局。2例母亲甲状腺功能异常者预后不良。56例中9例选择性引产，均伴有胎儿心功能异常，其中3例胎儿水肿，1例胎儿心脏结构异常。47例患者继续妊娠，结局良好43例；期前收缩1例分娩后随访心率过快，SB 1例分娩后随访心率减慢，1例SVT和1例心房扑动胎儿于新生儿期死亡。结论 胎儿心律失常总体预后良好，尤其胎儿期前收缩及单纯SB围产儿死亡率低，远期预后好。但是AVB、母体自身抗体阳性及胎儿心脏结构异常、胎儿水肿及胎儿心功能异常围产儿预后不良，临床干预应有所不同。

• Objective To investigate the perinatal management and short-term and long-term outcomes of fetal arrhythmia. Methods From January 2010 to December 2017, 72 pregnant women with persistent fetal arrhythmia diagnosed by fetal echocardiography in Beijing Anzhen Hospital， Capital Medical University were selected. The types of arrhythmia, age of pregnant women, confirmed gestational age, and history of early pregnancy diseases, past history, drugs treatment, the relationship of types among fetal arrhythmia， fetal edema, abnormal cardiac function, abnormal cardiac structure and adverse outcomes were recorded. Results  Among 72 cases of persistent fetal arrhythmia, there were 42 cases of premature contraction (58.3%), followed by 16 cases of supraventricular tachycardia (SVT), 6 cases of sinus bradycardia (SB), and atrial flutter. There were 5 cases of hyperactivity and 3 cases of atrioventricular block (AVB). Sixteen patients were lost to follow-up, including 11 cases of premature contractions, 4 cases of SVT and 1 case of SB. Other 56 cases were followed-up for 3-5 years. There were no significant differences in maternal age and confirmed gestational age among different types of fetal arrhythmia (all P>0.05). There were 21 cases using drugs due to fever in early pregnancy， including 1 case of atrial flutter, 1 case of AVB, 15 cases of premature contraction, 3 cases of SB, 1 case of SVT, and 5 cases of adverse pregnancy outcome. Two pregnant women with abnormal thyroid function had poor prognosis. Among the 56 cases of pregnant women, 9 cases of selective labor induction were accompanied with fetal cardiac dysfunction, including 3 cases of fetal edema and 1 case of fetal abnormal cardiac structure. There were 47 cases continued pregnancy, 43 cases with good outcomes; 1 case of premature contraction had fast heart rate after delivery, 1 case of SB had slow heart rate after delivery, and 1 fetus of SVT and 1 fetus of atrial flutter died in neonatal period. Conclusions The overall prognosis of fetal arrhythmia is good. Especially the perinatal mortality of premature contraction and simple SB are low, and the long-term prognosis is good. However, the prognosis of perinatal infants with AVB, maternal autoantibody positive, abnormal fetal cardiac structure, fetal edema and fetal cardiac dysfunction are poor. The clinical intervention should be different.