体位性心动过速综合征的诊断  

Diagnosis of Postural Orthostatic Tachycardia Syndrome in Children

作　　者：阿依古丽[1] 杜军保[1] 张清友[1] 陈永红[1] 

机构地区：[1]北京大学第一医院儿科,北京100034

出　　处：《实用儿科临床杂志》2006年第1期16-18,共3页Journal of Applied Clinical Pediatrics

基　　金："十五"国家攻关资助项目(2004BA720A10)

摘　　要：目的探讨体位性心动过速(POTS)的临床诊断方法。方法对符合诊断标准的POTS患儿36例,男15例,女21例,年龄5.9~16.0岁,平均年龄12.3岁,其中11~16岁28例,占78%。对其进行研究,分析年龄分布、病程及基础血液动力学指标,并观察其临床表现发生率及实验室查检查异常结果。结果POST患儿病程1 d^5.0年,平均为10.2个月,半数以上为6个月以内(占56%)。最常见临床表现为起立后胸闷、头晕、乏力、心悸、晕厥、眼前发黑、晨起不适等直立不耐受或直立调节障碍表现。10例伴恶心或呕吐等消化道症状,在直立倾斜试验(HUT)过程中POTS患儿最常见异常表现为HUT 10 min内,心率明显增快≥30次/min,平均为38次/min,部分患儿心率最大值≥120次/min。血压无明显变化。直立后心电图两个或两个以上导联T波下降≥0.2 mV 23例,占64%。实验室检查尿比重增高12例,HCO3-降低11例。结论POTS常见于学龄期女童,常见症状为头晕、胸闷、乏力、心悸,HUT为其诊断POST的重要方法。Objective To discuss the clinical diagnostic method of postural orthostatic tachycarda syndrome （POTS） in children. Methods Thirty - six children with POTS were selected for the research. Among them 15 were boys, 21 eases were girls. The age ranged from 5.9 to 16 years,average age 12.3 years. Among them 28 patients （78%） were in between 11 16 years. The age distribution,clinical courses and bemodynamic indexes were analyzed and also the incidence of clinical manifestations and investigation reports were observed. Results Among 81 patients of orthostatic regulation disturbance, 36 patients were diagnosed POTS, which was 47% of total. The clinical course.s ranged from 1 day to 5 years,average clinical course 10.2 months. The clinical courses of more than half of the total patients were within 6 months （56%）. The common clinical features of POTS were chest tightness on standing, vertigo, fatigue, palpitation, syncope, orthostatic regulation disturbance. Ten patients were also associated with gastrointestinal symptorns like nausea, vomiting. The most common feature of POTS patients was tachycardia （HR increased by ≥30 times/rain） within 10 min after head - up tilt test （HUT）. Average HR increased by 38 times/min. In some patients HR increased up to ≥ 120 times/min. There were no significant changes in blood. In 23 cases （64%） ,the T waves were descended by ≥0.2 mV in 2 or more than 2 leads in ECG reading. Investigations reports showed that there were 12 cases whose urine specific gravity was increased. In 11 cases H（X）3 decreased. Conclusions POTS is commonly seen in schooling female children. The common symptorns are vertigo, chest tightness, fatigue, palpitation. HUT ks an important method for the diagnosis of POTS.

关 键 词：心动过速 体位性 儿童 诊断 

分 类 号：R725.4[医药卫生—儿科]