https://scholars.lib.ntu.edu.tw/handle/123456789/194425
標題: | 複雜性先天心臟病術前術後心律不整之電生理學機轉:以同步電位及之體結構定位法研究(2/3) | 作者: | 吳美環 | 關鍵字: | 心律不整;複雜先天心臟病;傳導系統異常;Sudden death;complex congenta heart disease;conduction system anomalies | 公開日期: | 2001 | 出版社: | 臺北市:國立臺灣大學醫學院小兒科 | 摘要: | 兩側右心房症之病兒不但常合併有複 雜先天性心臟病,例如肺靜脈回流異常、 單一心房、心內膜墊缺損、單一心室及肺 動脈狹窄等,導致新生兒期之發紺或心衰 竭,同時也常合併心臟傳導系統異常,如 多重房室結及竇房結。這些傳導系統之異 常經常導致上心室頻脈。至於這些不整脈 的發生是否會影響這些病兒之預後,目前 仍不清楚。本研究以20 年之病兒長期追蹤 為研究對象,發現即使在接受心臟之輔助 手術治療,這些病兒極高的概率發生猝 死,這些猝死只有9%與心律不整有關。最 重要的仍是心肺功能不足(68)%,猛暴性感 染(23)%。 Sudden death in patients with right atrial isomerism after palliation Objectives. This longitudinal study sought to define the risk of sudden death in patients with right atrial isomerism (RAI, asplenia) after palliation. Study design. A total of 154 patients with RAI were identified from 1980 to 1999 based on a combination of various imaging techniques. Open-heart surgery or autopsy in 52 cases confirmed the diagnosis. Sudden death was defined as acute cardiovascular collapse from which biological death occurred within 24 hours. Results. A total of 620 patient-years were derived. The one-year and five-year survival was 72% and 50%, respectively. There were a total of 22 sudden unexpected deaths (14%, 35 events/1,000 patient-years). Sudden death tended to occur in the infancy or early childhood (12±9 mo., median, 9 mo.). The mechanisms were classified as sudden tachyarrhythmic in 2 (9%), sudden cardiac but nontachyarrrhythmic(sudden onset severe cyanosis) in 15 (68%), and sudden noncardiac in 5 (23%)(fulminant sepsis with positive blood culture: streptococcus pneumonia 3, E. coli 1 and yeast-like organism 1). Freedom from sudden death steadily decreased with age until the age of 3 years. Conclusions. The incidence of sudden death in RAI patients after initial palliation was still very high. The sudden death was related to the complex cardiac anomalies per se, a susceptibility to fulminant infection, and arrhythmia. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/22860 | 其他識別: | 892314B002492 | Rights: | 國立臺灣大學醫學院小兒科 |
顯示於: | 醫學系 |
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