Talwar Sachin, Patel Kartik, Juneja Rajnish, Choudhary Shiv Kumar, Airan Balram
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
Asian Cardiovasc Thorac Ann. 2015 Sep;23(7):795-801. doi: 10.1177/0218492315585457. Epub 2015 May 12.
This prospective study proposed to determine the incidence, risk factors, and management protocols for early postoperative arrhythmias after pediatric cardiac surgery, with focus on outcomes, using a uniform protocol, and also to see if children operated on at a later age have different issues from those operated on earlier.
Of 224 consecutive pediatric patients undergoing cardiac surgery from September 2013 to July 2014, 24 were excluded because their procedures were performed without cardiopulmonary bypass.
The median age was 24 months (mean 50.1 ± 62.4 months, range 0.5-216 months). Fifteen (7.5%) patients developed arrhythmia, the most common was junctional ectopic tachycardia (n = 7, 46.6%) followed by supraventricular tachycardia (n = 5, 33.3%). All junctional ectopic tachycardias occurred within 24 h of intensive care unit admission. Of the 7 patients with junctional ectopic tachycardia, 5 responded to conventional measures and 2 required amiodarone infusion. There was a significant longer cardiopulmonary bypass time in patients with arrhythmias compared to those without arrhythmias.
We observed a very low incidence of arrhythmias, particularly junctional ectopic tachycardia, after open heart surgery in children. Other than a longer cardiopulmonary bypass time, no specific predictors were identified. It appears that the cause of arrhythmias following pediatric cardiac surgery is multifactorial and needs further study with a greater number of patients.
本前瞻性研究旨在确定小儿心脏手术后早期心律失常的发生率、危险因素及管理方案，重点关注结局，采用统一方案，并观察大龄儿童手术患者与小龄儿童手术患者是否存在不同问题。
在2013年9月至2014年7月连续接受心脏手术的224例小儿患者中，24例因未进行体外循环手术而被排除。
中位年龄为24个月（平均50.1±62.4个月，范围0.5 - 216个月）。15例（7.5%）患者发生心律失常，最常见的是交界性异位性心动过速（n = 7，46.6%），其次是室上性心动过速（n = 5，33.3%）。所有交界性异位性心动过速均发生在重症监护病房入院后24小时内。7例交界性异位性心动过速患者中，5例对常规措施有反应，2例需要静脉输注胺碘酮。与未发生心律失常的患者相比，发生心律失常的患者体外循环时间明显更长。
我们观察到小儿心脏直视手术后心律失常的发生率很低，尤其是交界性异位性心动过速。除了体外循环时间较长外，未发现其他特定的预测因素。小儿心脏手术后心律失常的原因似乎是多因素的，需要对更多患者进行进一步研究。
