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小儿心律失常之过早搏动的诊断跟治疗
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[font=楷体_GB2312][size=5]过早搏动是由心脏异位兴奋灶发放的冲动所引起,为小儿时期最常见的心律失常。异位起波点可位于心房,房室交界或心室组织。分别引起房性、交界性及室性早搏其中以室性早搏为多见。

病因:常见于无器质性心脏病的小儿。可有哭闹、精神紧张、植物神经功能不稳定等引起。

小儿症状较成人为轻,常缺乏主诉,个别年长儿可叙述心悸、胸闷、不适。早搏次数因人而异,同一患儿在不同时间亦可有较大出入。某些患儿于运动后心率增快时早搏减少,但也有反而增多者。后者提示可能同时有器质性心脏病存在的可能。为了明确诊断,了解早搏的性质,必须作心电图检查。

心电图的诊断:

根据心电图有无P,波的存在、P,波的形态、P—R进期长短以及QRS波的形态来判断早搏属于何种类型。

1.房性早搏的心电图特征 (1)P,波提前,可与前一心动的T波重叠;(2)P,—R间期在正常范围;(3)早搏后代偿间隙不完全;(4)如伴有变形的QRS波则为心室内差异传导所致。

2.交界性早搏的心电图特征 (1)QRS波提琴,形态、时限与正常窦性基本相同;(2)早搏所产生的QRS波前或后有逆行P,波,P,—R<0.10s,有时P,波可与QRS波重叠,而辨认不清;(3)代偿间歇往往不完全。

3.室性早搏的心电图特征 (1)QRS波提前,其前无异位P波;(2)QRS波宽大、畸形、T波与主波方向相反;(3)早搏后多伴有完全代偿间歇。 必须针对基本病因治疗原发病,一般认为若早搏次数不多,无自觉症状,或早搏虽频发呈联律性,但形态一致,活动后减少或消失则不需无特需用药治疗。

[hide]治疗原则:

size=5>有些病人早搏可持续多年,但不说病人最终自行消退。对在器质性心脏病基础上出现的早搏或有自觉症状、心电图上呈多源性者,则应予以抗心律紊乱药物治疗。根据早搏的不同类型选用药物,可服用心律平或心得安等β受体阻滞剂。房性早搏若用之无效可改用洋地黄类。室性早搏必要时可选用利多卡因、慢性心律和乙吗噻嗪等。

【小儿心律失常预防】

1.生活要规律,养成按时作息的习惯,保证睡眠 2.洗澡水不要太热,洗澡时间不宜过长。 3.养成按时排便习惯,保持大便通畅。 4.饮食要定时定量。 5.避免着凉,预防感冒。 6.运动要适量,量力而行,不勉强运动或运动过量,不做剧烈及竞赛性活动。 7.合理用药 心律失常治疗中强调用药个体化,按医生要求服药,并注意观察用药后的反应。有些抗心律失常药有时能导致心律失常,所以,应尽量少用药,做到合理配伍。[/font]

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发布于 2009-05-17 18:34:25 IP 属地·中国|山东省|泰安市

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