胎儿完全性房室传导阻滞低心率时变速救援与延迟脐带结扎的新生儿结局
本研究为病例系列，纳入7例胎心率≤55 bpm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脉肾上腺素进行变速救援并延迟脐带结扎。结果显示该策略可提高新生儿心率并稳定需心外膜起搏器的新生儿，提示可能改善生存，但需进一步验证。
要点
- 胎心率≤55 bpm的完全性房室传导阻滞围产期死亡风险高。
- 产房变速救援联合延迟脐带结扎可提高新生儿心率并稳定循环。
- 该策略或可改善高危病例生存，但证据来自小样本病例系列。
诊断标准与关键数值
- 胎儿完全性房室传导阻滞伴胎儿心率≤55 bpm（分娩前12小时内）为纳入标准。
- 新生儿在出生后24小时至5天内接受心外膜起搏器植入。
临床应用与阅片要点
- 对胎心率≤55 bpm的完全性房室传导阻滞，可考虑产房变速救援联合延迟脐带结扎作为围产期管理策略。
- 需注意该策略为病例系列经验，应个体化评估并监测新生儿心率与循环。
局限性
- 样本量小（7例），为非对照病例系列，证据等级有限。
- 单中心经验，结果需更大样本研究验证。
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）。
英文原文（摘要）· 点击展开
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。