盐酸米多君和美托洛尔对儿童血管迷走性晕厥的干预研究  

Intervention study of midodrine hydrochloride and metoprolol in the treatment of children vasovagal syncope

作　　者：王成 许毅 刘晓燕 胡春艳 Praveen Kumar 吴礼嘉 胡尔林 崔晓丽 谢振武 

机构地区：[1]中南大学湘雅二医院儿科心血管病研究室中南大学儿科学研究所,长沙410011

出　　处：《中国急救医学》2009年第3期196-199,共4页Chinese Journal of Critical Care Medicine

基　　金：湖南省科技厅资助项目（No.06S10036,No.2008SK3111）;湖南省研究生创新基金项目（No.2340-74335000016）

摘　　要：目的探讨盐酸米多君和美托洛尔对儿童血管迷走性晕厥（VVS）的干预效果。方法2003-01—2007—04在中南大学湘雅二医院晕厥专科门诊就诊或住院的不明原因晕厥或晕厥先兆儿童51例，男17例，女34例，年龄6．92—18岁，平均（11．95±2．56）岁，随机给予盐酸米多君和美托洛尔治疗，治疗后2～4周复诊。其中46例患儿服药前后经过直立倾斜试验（HUTT）检查。结果①临床主观疗效：盐酸米多君组有效率与美托洛尔组比较差异无统计学意义（73．91％vs89．29％，P〉0．05）。②HUTT监测客观疗效：盐酸米多君组有效率较美托洛尔组低（54．54％vs70．83％，P〈0．05）。HUTT复查可见反应类型发生转变。两组服药前后HUTT各时间点的血流动力学指标（心率、收缩压、舒张压）比较差异无统计学意义（P〉0．05）。③药物副反应：盐酸米多君组未见明显副反应，美托洛尔组10．71％出现胃部不适、头痛等副反应。结论盐酸米多君和美托洛尔对儿童VVS治疗有效，但临床主观疗效未见差异，用HUTT客观评价则后者有效率高，表明儿童VVS疗效判断HUTT优于主观效果，两药在儿童临床应用中是安全的。Objective To explore the effect of midodrine hydrochloride and metoprolol on the treatment of vasovagal syncope （ VVS） in children. Methods 51 children with unexplained syncope and prodromata [ 17 male,34 female, aged （ 6.92 - 18 ） years, mean （ 11.95 ± 2.56 ） years ] were included in the study. They were given randomly midodrine hydrochloride and metoprolol for treatment, and after 2 -4 weeks return visit was carried out. Among them, there were 46 children who accepted HUTT. Results （1）Clinical subjective effect： there was no significant difference in effective rate between midodrine hydrochloride group and metoprolol group 173.91% vs. 89.29% ,P 〉0.05）. （2）Objective effect by HUTT： the effective rate for children in midodrine hydrochloride group was significantly lower than that in metoprolol group（54.54% vs. 70.83% ,P 〈0.05）. Change of the response type was seen in repeated HUTT. There was no statistical difference in hemodynamics index （ HR, SBP, DBP） between before and after therapy during HUTT （P 〉 0. 05）. （3）Side effects： no significant side effects were seen in midodrine hydrochloride group . 10.71% for children in metoprolol group showed stomach complaint, headache and so on. Conclusion Midodrine hydrochloride is as effective as metoprolol in the treatment of VVS children. There is no significant difference in clinical subjective effect between the two groups, but there is higher objective effective rate by HUTT in metoprolol group, which showed HUTT is superior to subjective judgement in the judgement of curative effect for children VVS. Both midodrine hydrochloride and metoprolol are safe for children in clinical application.

关 键 词：血管迷走性晕厥 盐酸米多君 美托洛尔 直立倾斜试验 儿童 

分 类 号：R720.597[医药卫生—急诊医学]