邬晓臣, 岳琴, 王舰, 刘敬臻, 张近宝. 高原先天性心脏病并发肺动脉高压患儿的围手术期心电图变化的意义[J]. 心脏杂志, 2021, 33(1): 36-38. DOI: 10.12125/j.chj.202008084
    引用本文: 邬晓臣, 岳琴, 王舰, 刘敬臻, 张近宝. 高原先天性心脏病并发肺动脉高压患儿的围手术期心电图变化的意义[J]. 心脏杂志, 2021, 33(1): 36-38. DOI: 10.12125/j.chj.202008084
    shu
    Xiao-chen WU, Qin YUE, Jian WANG, Jing-zhen LIU, Jin-bao ZHANG. Significance of the electrocardiogram changes in children with congenital heart disease combined with pulmonary hypertension at high altitude area[J]. Chinese Heart Journal, 2021, 33(1): 36-38. DOI: 10.12125/j.chj.202008084
    Citation: Xiao-chen WU, Qin YUE, Jian WANG, Jing-zhen LIU, Jin-bao ZHANG. Significance of the electrocardiogram changes in children with congenital heart disease combined with pulmonary hypertension at high altitude area[J]. Chinese Heart Journal, 2021, 33(1): 36-38. DOI: 10.12125/j.chj.202008084
    shu

    高原先天性心脏病并发肺动脉高压患儿的围手术期心电图变化的意义

    Significance of the electrocardiogram changes in children with congenital heart disease combined with pulmonary hypertension at high altitude area

      摘要
    • 摘要:
        目的  探索高原地区先天性心脏病（先心病）并发肺动脉高压患儿的心电图指标-P波变异度（Pw-d）和QT变异度（QT-d）在其围术期发生变化的临床意义。
        方法  选择2013年12月到2018年12月入本院来自高原地区先心病患儿60例，其中并发肺动脉高压的患儿30例为A组，不并发肺动脉高压的患儿30例为B组，同时选择本院儿科住院患儿（无先天性心脏病）30例为对照组，用心电图测定每一个先心病患儿的Pw-d和QT-d，同时进行超声心动图评价。如果心电监护发现心律失常的还需进行24 h动态心电图监测，以确认是否存在心律失常及心律失常的类型。
        结果  A组的QT平均时长、QT-d、P平均时长、Pw-d和平均心率显著高于B组和C组，A组的Pw-d或QT-d与射血分数无显著相关性，而与平均肺动脉压、右室基底部内径均呈显著正相关（P<0.05）。24 h心电图提示：A组10例出现心律失常，发生率为33%，B组及C组均无心律失常，其中室上性心动过速6例，心房扑动2例，房颤2例。心律失常患者的QT平均时长、QT-d、、Pw-d明显高于无心律失常患者（均P<0.01）
        结论  高原地区先心病并发肺动脉高压患儿术前心电图指标Pw-d和QT-d大的患者容易发生心律失常，对术后早期各种心律失常诊治具有较重要的临床预测意义。

       

      Abstract:
        AIM  To explore the clinical significance of P-wave variability (Pw-d) and QT variability (QTd) in the diagnosis and treatment of perioperative arrhythmia in children with congenital heart disease combined with pulmonary artery hypertension(PAH) at high altitude area.
        METHODS  From December 2013 to December 2018, 30 children with congenital heart disease combined with pulmonary hypertension from plateau area were selected as group A, 30 children with congenital heart disease without pulmonary hypertension as group B, and 30 children in department of pediatric of our hospital (without congenital heart disease) as control group. The Pw-d and QT-d of each patient were measured by electrocardiogram（ECG）. If arrhythmia is detected by ECG monitoring, 24-hour ECG monitoring was done to confirm the existence and the type of arrhythmia.
        RESULTS  The average length of QT, QT-d, P-mean time, Pw-d, and heart rate in group A were significantly higher than those in group B and C. There was no significant correlation between Pw-d or QT-d and EF in group A. However, significant positive correlation was observed between Pw-d or QT-d with MPAP and RVD (P < 0.05). 24-hour ECG showed that 10 patients in group A had arrhythmia, while 6 patients in group B and C had supraventricular tachycardia, 2 patients with atrial flutter (7%) and 2 patients with atrial fibrillation (7%). The average lengths of QT, QT-d and Pw-d in patients with arrhythmia were significantly higher than those in patients without arrhythmia (P < 0.05).
        CONCLUSION  Pw-d and QT-d have important clinical predictive significance for the diagnosis and treatment of various arrhythmias in children from highaltitudearea with congenital heart disease complicated with PAH preoperatively.

       

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