经射频消融术治疗的阵发性室上性心动过速患儿电生理和消融特征与年龄及性别的相关性研究-现代医学

经射频消融术治疗的阵发性室上性心动过速患儿电生理和消融特征与年龄及性别的相关性研究

作者：何梦陈梅

单位：南京医科大学附属儿童医院, 江苏南京 210000

分类号：R725.4

出版年·卷·期（页码）：2024·52·第九期（1405-1412）

摘要：

目的： 探究经射频消融术治疗的阵发性室上性心动过速(PSVT)患儿的电生理、消融特征及实验室指标与年龄及性别的相关性。方法： 回顾性分析2020年1月至2023年12月在我院行射频消融术治疗的156例PSVT患儿电生理、消融特征及实验室指标与年龄及性别的关联性。结果： 156例PSVT患儿中， 72例(46.15%)为房室结折返性心动过速(AVNRT)，84例(53.85%)为房室折返性心动过速(AVRT)。男性AVNRT比例高于AVRT(P＜0.05)；3~6岁患儿AVRT占比较高，7~10岁、11~14岁患儿中AVNRT占比较高(P＜0.05)；AVRT左侧旁道男性较多，右侧旁道女性较多(P＜0.05)；旁道仅有逆传功能者男性较多，旁道有双向传导功能女性较多(P＜0.05)。7~14岁患儿AVNRT比例高于3~6岁(P＜0.05)；3~6岁患儿旁道双向传导占比较高，7~14岁患儿中隐匿性旁道占比较高(P＜0.05)。射频消融术前，女性B型尿钠肽(BNP)水平高于男性，肌酸激酶同工酶(CK-MB)水平低于男性(P＜0.05)；术后12 h，女性氨基末端脑钠肽前体(NT-proBNP)水平高于男性(P＜0.05)；与术前比，所有患儿术后12 h的CK-MB、肌酸激酶(CK)水平均升高(P<0.05)；BNP、NT-proBNP、K⁺、Ca²⁺、Na⁺、血小板/淋巴细胞比值(PLR)、系统免疫炎症指数(SII)、红细胞分布宽度(RDW)水平均降低(P＜0.05)。射频消融术前，随着年龄增长，BNP水平升高(P＜0.05)，CK水平下降(P＜0.05)；术后12 h，随着年龄增长，NT-proBNP 水平上升(P＜0.05)；与术前相比，各年龄段患儿术后12 h的CK-MB、CK水平均升高(P＜0.05)；K⁺、Ca²⁺、Na⁺、PLR、SII、RDW均降低(P＜0.05)；各年龄段患儿术后BNP、NT-proBNP均降低(P<0.05)。结论： 患儿年龄与性别与不同类型PSVT的发生相关，且患儿年龄、性别与PSVT电生理、消融特征和部分实验室指标相关。

Objective: To investigate the correlation of electrophysiological and ablation characteristics and laboratory indexes with the age and gender in children with paroxysmal supraventricular tachycardia(PSVT) treated with radiofrequency ablation. Methods: The clinical data of 156 PSVT children treated with radiofrequency ablation in our hospital from January 2020 to December 2023 were retrospectively analyzed, and the correlation of electrophysiological and ablation characteristics and laboratory indexes with the age and gender was analyzed. Results: Among 156 cases of PSVT children, 72(46.15%) had atrioventricular nodal reentrant tachycardia(AVNRT) and 84(53.85%) had atrioventricular reentrant tachycardia(AVRT). The proportion of AVNRT in male children was significantly higher than that in AVRT(P＜0.05).The proportion of AVRT in children aged 3-6 years was higher, and the proportion of AVNRT in children aged 7-14 years was higher(P＜0.05). The proportion of AVNRT in children aged 7-14 years was significantly higher than that in children aged 3-6 years(P＜0.05). The proportion of bidirectional bypass conduction in children aged 3-6 years was higher, and the proportion of occult bypass tracts in children aged 7-14 years was higher(P＜0.05). Before radiofrequency ablation, the B-type natriuretic peptide(BNP) in female children was significantly higher than that in males, and the creatine kinase-MB isoenzyme(CK-MB) was significantly lower than that in males(P＜0.05). The N-terminal prohormones of brain natriuretic peptide(NT-proBNP) in female children were higher than those in males at 12 h after treatment(P＜0.05), and the CK-MB and creatine kinase(CK) in all children were significantly higher at 12 h after treatment(P＜0.05), while the BNP, NT-proBNP, K⁺, Ca²⁺, Na⁺, platelet-to-lymphocyte ratio(PLR), systemic immuno-inflammatory index(SII) and red cell distribution width(RDW) were significantly lower(P＜0.05). Before radiofrequency ablation, the BNP increased significantly with age(P＜0.05), while the CK decreased significantly(P＜0.05), the NT-proBNP increased significantly with age at 12 h after surgery(P＜0.05), and the CK-MB and CK increased significantly at 12 h after treatment(P＜0.05). The K⁺, Ca²⁺, Na⁺, PLR, SII and RDW decreased significantly(P＜0.05), while the postoperative BNP and NT-proBNP of children aged 7-14 years were significantly reduced(P＜0.05).Conclusion: The age and gender of children are associated with different types of PSVT, and with the electrophysiological, ablation characteristics and several laboratory indicators of PSVT children.

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