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目的了解晕厥患儿基础疾病谱,评价晕厥诊断程序在临床上应用的意义及卫生经济学价值。方法选取1985年1月至2014年12月在北京大学第一医院儿科收治的晕厥患儿935例,男421例(45%),女514例(55%);年龄1~18岁,平均(11.2±3.1)岁。分析儿童晕厥的基础疾病谱及晕厥诊断程序的卫生经济学价值。结果 1985—1994年,神经介导性晕厥(NMS)占6.7%,89.3%晕厥患儿基础疾病未明;1995—2004年,NMS占62%,其中主要包括血管迷走性晕厥(VVS)和体位性心动过速综合征(POTS),不明原因晕厥患儿发生率下降至28.3%;2005—2014年,NMS成为晕厥患儿的主要基础疾病,占80.7%,主要包括VVS及POTS等,心源性晕厥为5.4%,不明原因晕厥为13.9%。晕厥患儿平均住院日较2009年前显著缩短(P<0.001),晕厥患儿基础疾病诊断费用降低(P=0.048),住院总花费亦显著降低(P<0.001)。结论随着对儿童晕厥基础疾病的发现,儿童晕厥的基础疾病确诊率不断提高。构成儿童晕厥的基础疾病为VVS及POTS。儿童晕厥诊断程序具有良好的卫生经济学价值。
Objective To understand the basic disease spectrum of children with syncope and evaluate the significance of the clinical application of syncope diagnostic procedures and the value of health economics. Methods A total of 935 children with syncope were enrolled from January 1985 to December 2014 in Peking University First Hospital, including 421 males (45%) and 514 females (55%), ranging in age from 1 to 18 years, with an average of 11.2 ± 3.1) years old. Analyzing the underlying disease spectrum of syncope in children and the health economics value of syncope diagnostic procedures. Results In 1985-1994, NMS accounted for 6.7% and the underlying disease in 89.3% of children with syncope was unknown. From 1995 to 2004, NMS accounted for 62%, mainly including vasovagal syncope (VVS) and orthostatic Tachycardia syndrome (POTS), the incidence of unexplained syncope in children decreased to 28.3%; 2005-2014, NMS as the main underlying disease in children with syncope, accounting for 80.7%, including VVS and POTS, etc., cardiogenic Syncope was 5.4%, unexplained syncope was 13.9%. The average length of stay in children with syncope was significantly shorter than before 2009 (P <0.001). The cost of diagnosis of underlying diseases in children with syncope was decreased (P = 0.048) and the total cost of hospitalization was significantly lower (P <0.001). Conclusion With the discovery of basic diseases of syncope in children, the diagnosis rate of basic diseases of syncope in children is increasing. The underlying diseases that make up syncope in children are VVS and POTS. Children syncope diagnostic procedures have good health economics value.