单中心14例新生儿心房扑动的临床特点

So Hye Park, G. Lim, Ki Won Oh, J. Ko
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摘要

目的:心房扑动是新生儿期罕见的心律失常。本研究旨在描述新生儿心房扑动的病因和临床过程。方法:回顾性分析2008年3月至2020年8月在蔚山大学医院新生儿重症监护室(NICU)诊断为房扑的14名患者的病历。结果:14例均发生在出生第一天。其中,2名为足月儿,12名为早产儿。心房扑动的原因包括三例脐静脉导管错位,一例为糖尿病母亲,另一例为静脉注射氨茶碱后的象牙状心房扑动。13名患者心脏结构正常,无先天性心脏病。该患者的母亲患有糖尿病,患有房间隔缺损和心室肥大。首先给药腺苷是为了将其与阵发性室上性心动过速区分开来。11名患者尝试了同步复律,其中一名患者在注射艾司洛尔后接受了复律,但未能转换为窦性心律。一名患者在外周插入中心导管后复发;心房扑动复位后消失,出院后无复发。结论:新生儿心房扑动是一种罕见的快速性心律失常,其危险因素往往未知;然而,它可能发生在结构性心脏病、脐静脉导管定位错误以及母亲患有糖尿病的情况下。在脐静脉置管期间,临床医生应谨慎,并确保在新生儿重症监护室对婴儿进行适当的监测,因为这可能会导致并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neonatal Atrial Flutter: Clinical Characteristics of 14 Cases in a Single Center
Purpose: Atrial flutter is an uncommon arrhythmia in the neonatal period. This study aimed to describe the cause and clinical course of atrial flutter in neonates.Methods: The medical records of 14 patients diagnosed with atrial flutter at Ulsan University Hospital Neonatal Intensive Care Unit (NICU) between March 2008 and August 2020 were reviewed retrospectively.Results: All 14 cases occurred on the first day of birth. Of these, two were term infants, and 12 were preterm infants. Causes of atrial flutter included three cases of the umbilical venous catheter misplacement, one with a diabetic mother, and one ivolving atrial flutter after an intravenous aminophylline injection. Thirteen patients had structurally normal hearts with no congenital heart diseases. The patient, born to a diabetic mother, had an atrial septal defect and ventricular hypertrophy. Adenosine was administered first to differentiate it from paroxysmal supraventricular tachycardia. Synchronized cardioversion was attempted in 11 patients, while one received it after an esmolol injection that failed to convert to sinus rhythm. One patient had a recurrence after the intrusion of a peripherally inserted central catheter; however, atrial flutter disappeared after repositioning it. No patient had a recurrence after discharge.Conclusion: Neonatal atrial flutter is a rare tachyarrhythmia with the risk factors often unknown; however, it could occur in structural heart disease, mispositioning of the umbilical venous catheter, and if the mother has diabetes. During umbilical venous catheterization, clinicians should be cautious and ensure appropriate monitoring of infants in the NICU as it may cause complications.
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