心源性晕厥患儿病因治疗与预后  

Prognosis and Etiological Treatment of Cardiogenic Syncope in Children

作　　者：石秀兰[1] 李自普[1] 万顺兰[1] 王爱玲 

机构地区：[1]青岛大学医学院附属医院儿科,山东青岛266003 [2]青岛市四方区医院儿科,山东青岛266033

出　　处：《实用儿科临床杂志》2007年第1期37-38,共2页Journal of Applied Clinical Pediatrics

摘　　要：目的 探讨儿童心源性晕厥病因治疗与预后的关系。方法 回顾性分析本科收治的45例晕厥患儿的病因、临床表现、治疗及预后分为心律失常组和其他组，前者包括心肌炎、扩张性心肌病及先天性心脏病术后；后者包括法洛四联征、肺动脉狭窄、肥厚性心肌病、心包积液、右房粘液瘤。结果 45例患儿中以心律失常为主29例（64．44％）。其中完全性房室型传导阻滞（CAVB）18例，二度Ⅱ型房室型传导阻滞（AVB）2例，室性心动过速（室速）3例，心动过缓和心房扑动各2例，室上性心动过速（室上速）和未下传房性期前收缩各1例；其他16例（35．56％）。包括法洛四联症8例，肺动脉狭窄、肥厚型心肌病、心包积液和右房黏液瘤各2例。病毒性心肌炎致CAVB、心动过缓和室速者予抗病毒、营养心肌、异丙肾上腺素、大剂量维生素C100～200mg／（kg·d）、早期、大量、短程应用地塞米松1～2mg／（kg·d），部分患儿用人血丙种球蛋白；8例疗效不佳者安置临时起搏器，1例安置永久性起搏器。45例治愈38例（84．44％），好转3例（2．22％），死亡4例（8．88％）。结论 心源性晕厥是儿科急症，应及时处理，适时安置临时起搏器预屠好。Objective To explore the prognosis and etiological treatment of cardiogenic syncope in children. Methods The cause,clinical manifestation, treatment and prognosis of 45 children with syncope were made in affiliated hospital of Qingdao medical university were su mmarized and analyzed. They were divided into arhythmia group and other groups, the former included myocarditis, dilated cardiomyopathy, and postoperation of congenital heart disease and the latter included tetralogy of fallot ,pulmonary stenosis,hypertrophic cardiomyopathy,pericarclial effusion, and right atrial myxoma. Results There were 29 cases （ 64.44% ） with arrhythmia in this group, of which there were 18 cases with complete atrioventricular block（CAVB） ,2 cases with second degree type Ⅱ atrioventricular block ,3 cases with ventricular tachycardia,2 cases with bradycardia,2 cases with atrial flutter, 1 case with supraventricular tachycardia,and 1 case with nonconducting atrial premature. There were 16 cases（35.56% ） with other etiologies,of which there were 8 cases with tetralogy of Fallot,2 cases with pulmonary stenosis,hypertrop-hic cardiomyopathy, pericardial effusion, and right atrial myxoma, respectively. Children with CAVB, bradycardia, or ventricular tachycardia resulted from viral myocarditis were given anti - virus medicine,protecting myocardium,neoepinephrine,and intravenous vitamin C 100 - 200 mg/（kg·d）. Dexamethasone 1 -2 mg/（kg·d） was given in earlier period for short course,and some children were given human γ- globulin. Eight cases were placed temporary pacemaker because of unsatisfactory therapeutic efficacy, and 1 case was placed permanent pacemaker. In all,38 cases（84.44% ）were cured, 1 case（2.22% ）was improved,and 4 cases（8.88% ） died. Conclusions Cardiogenic syncope is pediatric emergency and shall be treated immediately. Temporary pacemaker shall be placed at the right moment.

关 键 词：晕厥 心源性 病因治疗 预后 儿童 

分 类 号：R725.4[医药卫生—儿科]