变时性救援联合延迟脐带结扎改善胎儿完全性房室传导阻滞新生儿结局
本病例系列纳入7例产前胎心率≤55次/分的胎儿完全性房室传导阻滞病例，在剖宫产前及脐带结扎前给予肌注和静注肾上腺素进行变时性救援，联合延迟脐带结扎，结果显示可提高新生儿心率并稳定需心外膜起搏器的新生儿。
要点
- 胎心率≤55次/分的胎儿完全性房室传导阻滞围产期死亡率高。
- 剖宫产前及脐带结扎前给予肾上腺素可提升新生儿心率。
- 变时性救援联合延迟脐带结扎或可改善高危病例生存。
核心结论
- 变时性救援联合延迟脐带结扎可能改善胎心率极低的高危胎儿完全性房室传导阻滞病例的生存。
研究设计与样本
- 病例系列研究，纳入7例产前12小时内胎心率≤55次/分的胎儿完全性房室传导阻滞胎儿。
主要发现
- 外源性肾上腺素联合延迟脐带结扎提高了新生儿心率。
- 接受心外膜起搏器的新生儿在出生后24小时至5天内得到稳定。
关键数值与推荐
- 胎儿完全性房室传导阻滞伴心室率≤55次/分与围产期死亡率增加相关。
- 干预措施为剖宫产前及脐带结扎前给予肌注和静注肾上腺素。
临床怎么用
- 对胎心率极低的高危胎儿完全性房室传导阻滞病例，围产期管理可考虑变时性救援联合延迟脐带结扎。
局限性
- 本研究为病例系列，样本量小，安全性和有效性需进一步验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Fetal complete atrioventricular block (f-CAVB) with ventricular bradycardia of ≤ 55 bpm is associated with increased perinatal mortality. With the goal of increasing perinatal survival of f-CAVB cases, we initiated a delivery room protocol to increase fetal heart rate (HR) and cardiac output using intramuscular and intravenous epinephrine given immediately before Cesarean delivery and prior to umbilical cord clamping. We tested the safety and efficacy of this concept of 'chronotropic rescue' in the delivery management of seven fetuses with f-CAVB meeting fetal HR criteria of ≤ 55 bpm in the 12 h prior to delivery. The combination of exogenous epinephrine and delayed umbilical cord clamping increased neonatal HR and stabilized the neonates who received an epicardial pacemaker < 24 h to 5 days after delivery. Based on the findings of this Case Series, chronotropic rescue with delayed umbilical cord clamping may improve survival and should be considered in the perinatal management of high-risk f-CAVB cases with very low fetal HR. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
引用
- Londono-Obregon C, Holmes S, Galan HL, et al. Neonatal outcomes following chronotropic rescue and delayed umbilical cord clamping in fetal complete atrioventricular block with low heart rate. Ultrasound Obstet Gynecol. 2026. PMID: 42069152. doi:10.1002/uog.70221
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。