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目的探讨直立倾斜试验(HUT)中血管迷走性晕厥(VVS)患儿的心率变化对美托洛尔治疗疗效的预测作用。方法将 HUT 或硝酸甘油激发 HUT(SNHUT)中阳性并接受美托洛尔治疗的26例 VVS 患儿作为研究对象,根据长期随访资料,将患儿分为美托洛尔治疗有效组(16例)及治疗无效组(10例),分析2组患儿在 HUT 或 SNHUT 过程中心率变化规律及其对美托洛尔治疗疗效的预测价值。结果 2组患儿的年龄、性别、晕厥次数、病程、基础心率、血压、应用 SNHUT 的情况、阳性反应类型及随访时间差异均无统计学意义。治疗有效组患儿在 HUT 或 SNHUT 过程中阳性反应前心率显著快,与治疗无效组相比差异有统计学意义[(123±15)次/min vs(96±17)次/min,P<0.01]。HUT 或 SNHUT 阳性反应前心率及较基础心率增加值在2组之间差异具有统计学意义[(42±16)次/min vs(18±13)次/min,P<0.01]。两组患儿在平卧位的基础心率及阳性发生时的心率改变差异无统计学意义,各阶段平均血压改变在两组之间差异均无统计学意义。取阳性反应前心率较基础心率增加30次/min 作为界点,预测患儿对美托洛尔治疗有效的灵敏度为81%(13/16),特异度为80%(8/10),诊断准确度为81%(21/26)。结论对在阳性反应前存在明显心率增快者(心率较基础值>30次/min者)选择应用β受体阻滞剂可能更加有效。
Objective To investigate the effect of heart rate changes in children with vasovagal syncope (VVS) on the prediction of the efficacy of metoprolol in upright tilt test (HUT). Methods Totally 26 children with VVS who were positive in HUT or nitroglycerine-activated HUT (SNHUT) and were treated with metoprolol were enrolled. According to the long-term follow-up data, the patients were divided into metoprolol-treated group (16 cases ) And treatment-ineffective group (n = 10). The changes of heart rate during HUT or SNHUT and the predictive value of metoprolol treatment in two groups were analyzed. Results There was no significant difference in age, sex, number of syncope, course of disease, basal heart rate, blood pressure, SNHUT application, type of positive reaction and follow-up time between the two groups. The treatment group had significantly higher heart rate before HUT or SNHUT positive reaction, compared with the ineffective treatment group [(123 ± 15) / min vs (96 ± 17) / min, P < 0.01]. HUT or SNHUT positive pre-reaction heart rate and basal heart rate increase in the two groups was statistically significant (42 ± 16) / min vs (18 ± 13) / min, P <0.01]. There was no significant difference in heart rate between the two groups in the supine position and the positive rate of heart rate. There was no significant difference in mean blood pressure between the two groups in the two groups. Take the heart rate before positive reaction than the basic heart rate increased 30 beats / min as a cut-off point, the prediction of metoprolol in children with effective sensitivity was 81% (13/16), specificity was 80% (8/10), the diagnosis The accuracy is 81% (21/26). Conclusions It may be more effective to choose β-blocker before the positive reaction with obvious increase of heart rate (heart rate> 30 beats / min).