胎儿心律失常的产前诊断和宫内治疗进展

doi:10.12280/gjfckx.20220244

摘要/Abstract

摘要：

胎儿心律失常的正确诊断对其治疗至关重要，可根据心律失常类型对胎儿进行个体化治疗，积极改善胎儿预后，提高胎儿存活率，避免不明原因胎儿宫内死亡的发生。临床上胎儿心律失常可分为3种类型：心脏节律不规则、快速心律失常和缓慢心律失常。诊断方式包括胎儿心电图、心磁图、脉冲多普勒及M型超声心动图。大部分胎儿心律失常为良性，通常不需要治疗，但需要密切随访。而对于伴随心功能不全或胎儿水肿的持续性胎儿心律失常，则需要宫内治疗。综述不同类型的胎儿心律失常的诊断方法、病因及治疗方案，加强胎儿宫内管理，改善胎儿围生结局。

关键词: 胎儿, 心律失常，心性, 心动过缓, 心动过速, 诊断, 治疗

Abstract:

Correct diagnosis of fetal arrhythmia is very important for its treatment. Individualized treatment of the fetus according to the type of arrhythmia can actively improve the prognosis of the fetus, improve the survival rate of the fetus, and avoid the occurrence of unexplained fetal intrauterine death. Clinically, fetal arrhythmias can be divided into three types: cardiac arrhythmia, tachyarrhythmia and bradyarrhythmia. Diagnostic methods include fetal electrocardiogram, magnetocar-diogram, pulse Doppler and M-mode echocardiography. Most fetal arrhythmias are benign and usually do not require treatment, but require close follow-up. For persistent fetal arrhythmias with cardiac insufficiency or fetal edema, intrauterine treatment is required. This article summarizes the diagnosis methods, causes and treatment plans of different types of fetal arrhythmias, strengthen intrauterine management, and improve the perinatal outcome of the fetus.

Key words: Fetus, Arrhythmia, cardiac, Bradycardia, Tachycardia, Diagnosis, Therapy

宋双, 乔宠. 胎儿心律失常的产前诊断和宫内治疗进展[J]. 国际妇产科学杂志, 2022, 49(6): 649-654.

SONG Shuang, QIAO Chong. [J]. Journal of International Obstetrics and Gynecology, 2022, 49(6): 649-654.

图/表 2

表1 CVPS评分系统

指标	2分	1分	0分
胎儿水肿	无	心包积液或胸腹水	胎儿水肿
心/胸面积比	心胸面积比0.25~0.35	>0.35~0.5	<0.25或>0.5
心脏功能	瓣膜无返流	三尖瓣返流	二尖瓣返流
脐动脉血流频谱	正常	舒张期血流消失	舒张期血流反向
静脉导管频谱	正常	a波反向	a波消失

图1 胎儿心动过速治疗流程注：CVPS 心血管整体评分，A 心房，V 心室，AR 心房率，VR 心室率，AF 心房扑动，ST 窦性心动过速，VT 室性心动过速，AVB 房室传导阻滞，SVT 室上性心动过速，AVRT 房室折返性心动过速，AVNRT 房室结折返性心动过速，SART 窦房折返性心动过速，LQTS 长QT综合征，VD 维生素D。

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