胎儿心律失常产前治疗及管理专家指导意见

doi:10.3877/cma.j.issn.1673-5250.2022.01.003

中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (01) : 15 -29. doi: 10.3877/cma.j.issn.1673-5250.2022.01.003

标准·方案·指南

胎儿心律失常产前治疗及管理专家指导意见

中华医学会儿科学分会心血管学组胎儿心脏病协作组, 中华医学会儿科学分会心血管学组围产期先天性心脏病诊疗协作组, 周开宇¹^,¹, 陈笋²^,², 王川¹^,¹, 李一飞¹^,¹, 潘微³^,³, 赵博文⁴^,⁴, 张玉奇⁵^,⁵, 逄坤静⁶^,⁶, 丁文虹⁷^,⁷, 任芸芸⁸^,⁸, 林建华⁹^,⁹, 韩波¹⁰^,¹⁰, 吕海涛¹¹^,¹¹, 张清友¹²^,¹², 武育蓉²^,², 刘保民¹³^,¹³, 吴琳¹⁴^,¹⁴, 张艳敏¹⁵^,¹⁵, 肖婷婷¹⁶^,¹⁶, 何怡华¹⁷^,^†^,¹⁷(

), 华益民¹^,^†^,¹(

)

收稿日期:2021-06-11 修回日期:2021-12-13 出版日期:2022-02-01
通信作者: 何怡华, 华益民

Expert guidance on prenatal treatment and management for fetal arrhythmia

Feta Heart Disease Cooperation Team of Pediatric Cardiovascular Group of Chinese Pediatric Society of Chinese Medial Association, Perinatal Congenital Heart Disease Cooperation Team of Pediatric Cardiovascular Group of Chinese Pediatric Society of Chinese Medial Association, Kaiyu Zhou¹^,¹, Sun Chen²^,², Chuan Wang¹^,¹, Yifei Li¹^,¹, Wei Pan³^,³, Bowen Zhao⁴^,⁴, Yuqi Zhang⁵^,⁵, Kunjing Pang⁶^,⁶, Wenhong Ding⁷^,⁷, Yunyun Ren⁸^,⁸, Jianhua Lin⁹^,⁹, Bo Han¹⁰^,¹⁰, Haitao Lyu¹¹^,¹¹, Qingyou Zhang¹²^,¹², Yurong Wu²^,², Baomin Liu¹³^,¹³, Lin Wu¹⁴^,¹⁴, Yanmin Zhang¹⁵^,¹⁵, Tingting Xiao¹⁶^,¹⁶, Yihua He¹⁷^,¹⁷^,^†(), Yimin Hua¹^,¹^,^†()

Received:2021-06-11 Revised:2021-12-13 Published:2022-02-01
Corresponding author: Yihua He, Yimin Hua
Supported by:
Key Research and Development Program of the Ministry of Science and Technology of China(2018YFC1002301, 2018YFC1002300); National Natural Science Foundation of China(82070324, 81800288); Key Research and Development Program of Science and Technology Department of Sichuan Province(2020YFS0101, 2019YJ0024, 2021YJ0211, 2021YFS0094)

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中华医学会儿科学分会心血管学组胎儿心脏病协作组, 中华医学会儿科学分会心血管学组围产期先天性心脏病诊疗协作组, 周开宇, 陈笋, 王川, 李一飞, 潘微, 赵博文, 张玉奇, 逄坤静, 丁文虹, 任芸芸, 林建华, 韩波, 吕海涛, 张清友, 武育蓉, 刘保民, 吴琳, 张艳敏, 肖婷婷, 何怡华, 华益民. 胎儿心律失常产前治疗及管理专家指导意见[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(01): 15-29.

Feta Heart Disease Cooperation Team of Pediatric Cardiovascular Group of Chinese Pediatric Society of Chinese Medial Association, Perinatal Congenital Heart Disease Cooperation Team of Pediatric Cardiovascular Group of Chinese Pediatric Society of Chinese Medial Association, Kaiyu Zhou, Sun Chen, Chuan Wang, Yifei Li, Wei Pan, Bowen Zhao, Yuqi Zhang, Kunjing Pang, Wenhong Ding, Yunyun Ren, Jianhua Lin, Bo Han, Haitao Lyu, Qingyou Zhang, Yurong Wu, Baomin Liu, Lin Wu, Yanmin Zhang, Tingting Xiao, Yihua He, Yimin Hua. Expert guidance on prenatal treatment and management for fetal arrhythmia[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(01): 15-29.

胎儿心律失常(FA)是产科及儿童心血管科门诊常见的胎儿疾病，约10% FA可持续存在或进展，导致重要脏器继发性损伤及胎儿心力衰竭，甚至可导致胎儿早产及死亡。在准确的产前诊断基础上，对FA的性质进行甄别，对严重FA进行及时恰当干预，改善胎儿预后，具有极大的医学及社会学意义。目前国外在FA产前干预方案制定，以及治疗药物评价等方面均取得较多进展，但是国内相关研究尚较少，不同研究对FA的产前治疗及管理差异均较大。为提高中国儿科及围生医学科医师对FA产前管理认识，严格把控FA临床治疗适应证，规范治疗策略，推动FA产前干预在国内的健康良性发展，中华医学会儿科学分会心血管学组胎儿心脏病协作组、围产期先天性心脏病诊疗协作组组织相关专家，结合国内外FA产前治疗及管理的最新研究进展与国内实际，经过充分讨论，对我国FA产前干预指征、干预策略、药物治疗选择等，达成初步共识后，制定《胎儿心律失常产前治疗及管理专家指导意见》。但是，目前国外关于快速及缓慢性FA产前干预的临床研究，多局限于单中心、回顾性及小样本研究，不同研究的干预方案差异较大，临床证据级别较低。随着国内外FA产前干预工作的进一步发展，部分多中心、前瞻性随机对照临床试验研究数据的发布，在国内同道共同努力下，本意见内容将不断更新、完善，也将更符合国内临床实践需求，达到促进FA产前治疗及管理不断进步的目的。

关键词: 心律失常，心性, 心率，胎儿, 心动过速，室上性, 心房扑动, 房室传导阻滞, 超声心动描记术，压力, 产前诊断, 水肿，胎儿, 诊疗工作管理，医学, 胎儿

Fetal arrhythmias (FA) are common cardiac disorders in clinics of obstetrics and pediatric cardiology. Approximately 10% FA could persist or even progress, which may result in secondary organ injury, such as fetal heart failure, fetal premature delivery or even fetal demise. Based on accurate prenatal diagnosis of FA, reasonable classification and timely intervention for severely affected fetuses could improve prognosis of FA, which has great medical and sociological significance. Despite much progress have been achieved in field of prenatal management of FA in foreign countries, there are a few relevant studies in China. Moreover, there are great differences in prenatal management strategies for FA among different medical centers. In order to improve understanding of perinatal management of FA for obstetricians and pediatricians, standardize the intervention indications and treatment strategies, and promote the benign development of prenatal intervention for FA in China, experts from the Fetal and Perinatal Heart Disease Cooperation Team of Pediatric Cardiovascular Group of Chinese Pediatric Society, Chinese Medial Association put forward the Expert Guidance on Prenatal Treatment and Management for Fetal Arrhythmia after full discussion on prenatal intervention indications, treatment strategies as well as details of medicines selections according to the latest research progresses and current domestic situations. However, relevant clinical studies are limited to single-center, retrospective, and small sample size studies and the conclusions differed among different studies. Furthermore, only a minority of data were from China. Therefore, the evidences level are not so high. With further development of prenatal intervention for FA, the release of data from several multiple-centers, prospective and randomized controlled clinical studies, and with joint efforts of domestic clinicians, the content of this guidance will continue to be update and improved, and it will also be more in line with the actual domestic clinical practice needs, to achieve the goal of promoting continuous improvement of prenatal treatment and management of FA.

Key words: Arrhythmias, cardiac, Heart rate, fetal, Tachycardia, supraventricular, Atrial flutter, Atrioventricular block, Echocardiography, stress, Prenatal diagnosis, Hydrops fetalis, Practice management, medical, Fetus

图1 胎儿SVA干预流程图注：SVA为室上性心率失常，SVT为室上性心动过速，AF为心房扑动，FA为心率失常，FHR为胎心率，CVPS为心血管剖面评分，FH为胎儿水肿

图2 缓慢性FA干预流程图注：FA为胎儿心率失常，AVB为房室传导阻滞，FHR为胎儿心率，IVIG为静脉注射免疫球蛋白，EFE为心内膜弹力纤维增生症，DCM为扩张型心肌病

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Expert guidance on prenatal treatment and management for fetal arrhythmia

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Expert guidance on prenatal treatment and management for fetal arrhythmia