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目的探讨不明原因晕厥儿童在直立倾斜试验中不同血流动力学类型及其分布,研究不同血流动力学类型与其临床表型之间的关联。方法对100例不明原因晕厥儿童均进行直立倾斜试验(HUT)或舌下含化硝酸甘油激发直立倾斜试验,并根据其在实验中不同的血流动力学反应分为血管迷走性反应型、体位性心动过速综合征反应型、体位性低血压反应型及正常血流动力学反应型4种类型,研究其分布及比较其临床特征。结果100例不明原因晕厥患儿HUT中,50例(50%)出现经典的血管迷走性反应型,33例出现体位性心动过速综合征反应型(33%),15例出现正常反应型(15%),2例出现体位性低血压反应型(2%)。其中在50例血管迷走性反应型中,31例为血管抑制型(31%),12例为混合型(12%),7例为心脏抑制型(7%)。血管迷走性反应型及体位性心动过速反应型的患儿平均年龄大于正常血流动力学反应型的患儿(12±2vs10±3,P<0·01;12±2vs10±3,P<0·01);各种血流动力学类型之间男女性别比没有显著性差异;各种血流动力学类型之间病程的比较亦没有显著性差异;体位性心动过速综合征反应型患儿的晕厥次数显著少于血管迷走性反应型及正常反应型患儿(1±1vs3±3,P<0·01,1±1vs3±2,P<0·01);体位性心动过速综合征反应型基础心率显著快于血管迷走性反应型及正常反应型患儿(81±7vs71±9,P<0·01,81±7vs74±7,P<0·01);基础血压在各种血流动力学类型之间比较都没有显著性差异。发病年龄、性别、病程长短、晕厥次数、基础心率及基础收缩压和舒张压,在血管迷走性反应各亚型之间相比较均无显著性差异。结论不明原因晕厥儿童在直立倾斜试验中可表现出不同的血流动力学反应类型,不同的血流动力学类型之间与其临床表型有一定的关联。
Objective To investigate the different types and distribution of hemodynamics in children with unexplained syncope in upright tilt test and to study the relationship between different hemodynamic types and their clinical phenotypes. Methods Eighteen patients with unexplained syncope were examined by upright tilt test (HUT) or sublingual nitroglycerin-induced erection tilt test. According to their different hemodynamic responses, vasovagal reaction type, position Tachycardia syndrome reactive orthostatic hypotensive response and normal hemodynamic response of four types, to study the distribution and compare their clinical features. Results 50 cases (50%) of the 100 children with unexplained syncope had classic vasovagal reaction type, 33 cases had orthostatic tachycardia reaction type (33%) and 15 cases had normal reaction type 15%), 2 cases of orthostatic hypotensive response (2%). Of the 50 patients with vasovagal reaction, 31 were vasoconstrictor (31%), 12 were mixed (12%) and 7 were cardioverter (7%). The average age of children with vasovagal or orthostatic tachycardia was significantly higher than those with normal hemodynamic response (12 ± 2 vs10 ± 3, P <0.01; 12 ± 2 vs 10 ± 3, P < 0 · 01). There was no significant difference in the sex ratio of men and women among various hemodynamic types. There was no significant difference in the course of disease between various hemodynamic types. Patients with orthostatic tachycardia syndrome The frequency of syncope in children was significantly less than that in children with vasovagal reaction and normal reaction (1 ± 1 vs 3 ± 3, P <0.01, 1 ± 1 vs 3 ± 2, P <0.01); orthostatic tachycardia syndrome The basal heart rate was significantly higher in patients with vasovagal reaction and normal reaction (81 ± 7 vs 71 ± 9, P <0.01, 81 ± 7 vs 74 ± 7, P <0.01) There was no significant difference between hemodynamic types. Age, gender, duration of disease, frequency of syncope, basal heart rate and basal systolic and diastolic blood pressure were not significantly different in all subtypes of vasovagal reactions. Conclusions Children with unexplained syncope can show different hemodynamic responses in up-tilt test. The different types of hemodynamics correlate with their clinical phenotypes.