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[儿童永久性折返性心动过速的医学治疗与长期发展。附10例随访11年的病例]

[Medical treatment and long-term development of permanent reciprocal tachycardia in children. Apropos of 10 cases followed for 11 years].

作者信息

Lucet V, Do Ngoc D, Sidi D, Batisse A, Fidelle J, Coumel P

出版信息

Arch Mal Coeur Vaiss. 1985 Feb;78(2):210-6.

PMID:3920990
Abstract

Incessant reciprocating tachycardia (IRT) was diagnosed in 10 children aged 0-11 years (mean 2.5 years), followed-up for an average of 11 years (range 4-22 years). 8 children were treated for an average period of 2.8 years (range 0.5-6 years) with the association of amiodarone and digitoxine. All children were treated initially or secondarily with verapamil and/or betablockers with digitoxine for an average of 4.6 years (range 1-9 years). The true frequency of IRT, its tolerance and the age at diagnosis did not indicate the probable required length of treatment with amiodarone, but only the initial response to this drug. Finally, 5 patients were cured and in sinus rhythm, and the other 5 were well controlled, having only occasional bursts of tachycardia. When we compared one group of 5 cases with clinical signs of cardiac failure and radiological cardiomegaly (CTR greater than 0.60) with a second group of 5 cases in which the arrhythmia was better tolerated, surprisingly, the frequency of intreated IRT was not t he factor which influenced its tolerance (198/min vs 194/min). On the other hand, the following differences were observed between the two groups: a younger age at diagnosis in the first group (5 months vs 4.6 years) responsible for the longer follow-up period (14.5 vs 7 years), earlier treatment period with amiodarone (3.6 years compared to 5.5 years) and a longer treatment period with this drug (3.5 vs 2 years). It was only at about the age of 7 that this treatment could be withdrawn or changed with half the children completely cured, and the other half only controlled.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

10名年龄在0至11岁(平均2.5岁)的儿童被诊断为持续性折返性心动过速(IRT),平均随访11年(范围4至22年)。8名儿童联合使用胺碘酮和洋地黄毒苷平均治疗2.8年(范围0.5至6年)。所有儿童最初或继发使用维拉帕米和/或β受体阻滞剂及洋地黄毒苷平均治疗4.6年(范围1至9年)。IRT的实际发生率、耐受性及诊断年龄并未表明胺碘酮治疗可能所需的疗程,仅表明对该药物的初始反应。最终,5例患者治愈且恢复窦性心律,另外5例得到良好控制,仅偶尔出现心动过速发作。当我们将一组有心力衰竭临床体征和放射学心脏扩大(心胸比率大于0.60)的5例患者与另一组心律失常耐受性较好的5例患者进行比较时,令人惊讶的是,未治疗的IRT频率并非影响其耐受性的因素(198次/分钟对194次/分钟)。另一方面,两组之间观察到以下差异:第一组诊断年龄较小(5个月对4.6岁)导致随访期较长(14.5年对7年),胺碘酮治疗开始时间较早(3.6年对5.5年)且该药物治疗疗程较长(3.5年对2年)。仅在约7岁时,半数儿童可停药或更改治疗方案,其中一半完全治愈,另一半仅得到控制。(摘要截选至250字)

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