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目的探讨不同血流动力学类型血管迷走性晕厥(vasovagal syncope,VVS)患儿的个体化治疗方案。方法对2004年4月至2010年6月在北京大学第一医院就诊的63例VVS患儿进行门诊或电话随访。年龄6～19岁,平均(11.57±2.89)岁。其中血管抑制型32例、混合型、心脏抑制型31例,服用口服补液盐者14例、美托洛尔13例、盐酸米多君36例。随访时间3～48个月,平均(21±12)个月。分析采用不同治疗的不同血流动学类型VVS患儿3个月内复发情况,评价短期疗效;以复发为终点事件,作Kaplan-Meier曲线,比较VVS患儿应用不同治疗的长期疗效。结果以上3种治疗药物对不同血流动力学类型VVS患儿的短期疗效差异无统计学意义(P均>0.05)。不同血流动力学类型VVS患儿接受口服补液盐或美托洛尔治疗后,长期疗效差异均无统计学意义(P>0.05),盐酸米多君对混合型及心脏抑制型VVS的疗效优于血管抑制型(P<0.01)。结论口服补液盐、美托洛尔或盐酸米多君均适于VVS患儿的治疗,与VVS血管抑制型患儿相比,盐酸米多君对混合型及心脏抑制型患儿的长期疗效更佳。
Objective To investigate the individualized treatment of vasovagal syncope (VVS) patients with different hemodynamics. Methods 63 patients with VVS who visited the First Hospital of Peking University from April 2004 to June 2010 were followed up by phone or by phone. Aged 6 to 19 years, mean (11.57 ± 2.89) years. Among them, 32 were vascular suppression, 31 were mixed and cardiac inhibition, 14 were oral rehydration salts, metoprolol was 13 and Midodrine hydrochloride was 36. The follow-up time ranged from 3 to 48 months, with an average of (21 ± 12) months. To analyze the recurrence of children with different hemodynamics type VVS in three months and to evaluate the short-term efficacy. To compare the long-term effects of different treatments in Kaplan-Meier curves with recurrence as the end point. Results There was no significant difference in the short-term curative effect of the above three kinds of drugs on children with different hemodynamics type VVS (all P> 0.05). There was no significant difference in the long-term effects of oral administration of oral rehydration salts or metoprolol in children with different hemodynamic types of VVS (P> 0.05), and the efficacy of midodrine hydrochloride in mixed and cardiovertic VVS patients was excellent In vasoconstrictor type (P <0.01). Conclusions Oral rehydration salts, metoprolol or midodrine hydrochloride are suitable for the treatment of children with VVS. Compared with VVS-suppressed children, midodrine hydrochloride has more long-term effects on mixed and cardioreactive children good.