儿童房性期前收缩的临床特征及危险因素评估
인동방성기전수축적림상특정급위험인소평고
Clinical characteristics and risk factors evaluation of premature atrial contractions in children
  • 万方数据
    中华实用儿科临床杂志 중화실용인과림상잡지
    Journal of Applied Clinical Pediatrics
    2014年 13期 983-986 ,共4页

    石琳%林瑶%刘杨%梁璐%丛晓辉%郑彤%赵地%汪芸

    석림%림요%류양%량로%총효휘%정동%조지%왕예

    房性期前收缩%特征%运动试验%儿童 房性期前收縮%特徵%運動試驗%兒童
    방성기전수축%특정%운동시험%인동
    Premature atrial contraction%Characteristics%Exercise test%Child
    目的 探讨小儿房性期前收缩的临床特征和危险因素.方法 2006年10月至2011年12月在首都儿科研究所经询问病史、体格检查、心肌酶谱、超声心动图、心电图等检查确诊为无器质性心脏病的房性期前收缩患儿212例,分析其临床特点.169例患儿完成24 h动态心电图(Holter)和平板运动试验.结果 (1)212例房性期前收缩患儿以4～6岁和≥11岁者比值略高,分别为28.8％(61/212例)和29.8％(63/212例);男女比例为1.0∶1.1.(2)139例(65.6％)房性期前收缩患儿无任何临床症状,73例(34.4％)有临床症状,其中长出气发生率高达83.6％(61/73例).(3)无症状的房性期前收缩患儿在常规体检中发现占61.2％ (85/139例),在患感染性或其他疾病就诊过程中发现占38.8％(54/139例),感染(36/54例)为主要诱因.(4)房性期前收缩患儿和健康儿童在基础心率、血压、心脏大小及心功能上差异均无统计学意义(P均＞0.05).(5)24h房性期前收缩的数量分布:＜5000个占49.5％(105/212例),5 000～20 000个占36.8％(78/212例),＞20 000个占13.7％(29/212例).(6) 169例房性期前收缩患儿平板运动试验结果:运动中、后期前收缩减少或消失的135例,占79.8％;运动中期前收缩增多,出现多形性期前收缩,运动停止出现交界性逸搏心律、成对期前收缩及ST-T改变等的34例,占20.2％.(7)24 h期前收缩频率＜5000个,5 000～20000个及＞20 000个的患儿平板运动试验阳性率分别为20.2％(17/84例)、20.3％(13/64例)、19.0％(4/21例),组间差异无统计学意义(x2=0.017,P=0.991).(8)期前收缩日间多发(102例)与夜间多发型(67例)运动试验阳性率分别为28.4％(29/102例)和7.5％(5/67例),差异有统计学意义(x2 =0.001,P=0.001).结论 房性期前收缩患儿有其年龄分布特点,多数患儿无临床症状,感染是症状性期前收缩的常见诱发因素;房性期前收缩需要行24 h动态心电图了解期前收缩的分布情况,做运动试验可对期前收缩的运动危险性做出评价.
    목적 탐토소인방성기전수축적림상특정화위험인소.방법 2006년10월지2011년12월재수도인과연구소경순문병사、체격검사、심기매보、초성심동도、심전도등검사학진위무기질성심장병적방성기전수축환인212례,분석기림상특점.169례환인완성24 h동태심전도(Holter)화평판운동시험.결과 (1)212례방성기전수축환인이4～6세화≥11세자비치략고,분별위28.8％(61/212례)화29.8％(63/212례);남녀비례위1.0∶1.1.(2)139례(65.6％)방성기전수축환인무임하림상증상,73례(34.4％)유림상증상,기중장출기발생솔고체83.6％(61/73례).(3)무증상적방성기전수축환인재상규체검중발현점61.2％ (85/139례),재환감염성혹기타질병취진과정중발현점38.8％(54/139례),감염(36/54례)위주요유인.(4)방성기전수축환인화건강인동재기출심솔、혈압、심장대소급심공능상차이균무통계학의의(P균＞0.05).(5)24h방성기전수축적수량분포:＜5000개점49.5％(105/212례),5 000～20 000개점36.8％(78/212례),＞20 000개점13.7％(29/212례).(6) 169례방성기전수축환인평판운동시험결과:운동중、후기전수축감소혹소실적135례,점79.8％;운동중기전수축증다,출현다형성기전수축,운동정지출현교계성일박심률、성대기전수축급ST-T개변등적34례,점20.2％.(7)24 h기전수축빈솔＜5000개,5 000～20000개급＞20 000개적환인평판운동시험양성솔분별위20.2％(17/84례)、20.3％(13/64례)、19.0％(4/21례),조간차이무통계학의의(x2=0.017,P=0.991).(8)기전수축일간다발(102례)여야간다발형(67례)운동시험양성솔분별위28.4％(29/102례)화7.5％(5/67례),차이유통계학의의(x2 =0.001,P=0.001).결론 방성기전수축환인유기년령분포특점,다수환인무림상증상,감염시증상성기전수축적상견유발인소;방성기전수축수요행24 h동태심전도료해기전수축적분포정황,주운동시험가대기전수축적운동위험성주출평개.
    Objective To investigate clinical characteristics and risk factors for premature atrial contractions in children,which will provide effective reference for diagnosis and evaluation of premature atrial contractions.Methods Through history collection,physical examination,echocardiogram and electrocardiogram examination,212 children were enrolled,who were diagnosed as premature atrial contractions without organic heart diseases.All clinical data of these children were analyzed.One hundred and sixty-nine children received dynamic electrocardiogram and treadmill exercise test.Results (1) Age distribution:28-day to 1-year old children with the rate of 10.8％ (23/212 cases),1 to 3-year old with 9.4％ (20/212 cases),4 to 6-year old with 28.8％ (61/212 cases),7 to 10-year old with 21.2％ (45/212 cases) and ≥ 11-year old with 29.8％ (63/212 cases).There were 101 boys and 111 girls,with the ratio of 1.0:1.1.(2) There were 139 children(65.6％) without any symptoms,and 73 children(34.4％) with some symptoms,which mainly included sighing,oppression in chest,weakness,breath holding,palpitation,dizzy and pale complexion.The occurrence of sighing was higher to 83.6％ (61/73 cases).(3) There were 85 children(61.2％) without symptoms who were found to have premature atrial contractions by routine physical examination,and there were 54 children(38.8％) who were found to have premature atrial contractions during visiting doctors because of other diseases such as infectious diseases.Usually,there were some incentive factors,such as infection(36/54 cases),exercise(15/54 cases),mental stress(11/54 cases) and fatigue(7/54 cases),among which infection was the most common one.(4) Between healthy children and those with premature atrial contractions,there was no statistic difference in basic heart rate,blood pressure,left ventricular end systolic dimension(LVDs),left ventricular end diastolic dimension (LVDd),ejection fraction,shortening fraction,and left atrial diameter(all P ＞ 0.05).(5) Number distribution of dynamic electrocardiogram per 24 hours:＜ 5 000 with the rate of 49.5 ％ (105/212 cases),5 000 to 20 000 with 36.8％ (78/212 cases),and ＞ 20 000 with 13.7％ (29/212 cases).(6) Exercise test of 169 children:during and after exercise,there were 135 children(79.8％) with decreased or disappeared premature contractions.There were 34 children(20.2％) with increased and pleomorphism premature contractions during exercise,and junctional escape rhythm,pairing premature contractions or ST-T changes.(7) Relation between frequency of premature contraction and treadmill exercise test:positive rates of exercise test were 20.2％ (17/84 cases),20.3％ (13/64 cases) and 19.0％ (4/21 cases) of children with ＜5 000/24 hours,5 000 to 20 000/24 hours and ＞20 000/24 hours respectively.There was no statistic significance among groups (x2 =0.017,P =0.991).(8) Relation between apex time with exercise test:there was some relationship between premature contractions and sympathetic activity.Positive rate of daytime type (102 children) and nighttime type(67 children) were 28.4％ (29/102 cases)and 7.5％ (5/67 cases)respectively.There was statistic significance between the 2 types (x2 =0.001,P =0.001).Conclusions Children with premature atrial contractions have marked clinical characteristics in age distribution,and most children have no obvious symptoms.Infection is the most common incentive fact.It is necessary to finish dynamic electrocardiogram to investigate the distribution of premature contractions,and to finish exercise test to evaluate the risk degree of exercise for children with premature atrial contrac tions.
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