不同血流动力学类型血管迷走性晕厥63例预后研究  

Follow-up study of the efficacy of different therapies on vasovagal syncope in children with different hemodynamic patterns

作　　者：张凤文[1] 廖莹[1] 李雪迎[1] 陈丽[1] 金红芳[1] 杜军保[1] 

机构地区：[1]北京大学第一医院儿科,北京100034

出　　处：《中国实用儿科杂志》2011年第2期97-100,共4页Chinese Journal of Practical Pediatrics

基　　金：首都医学发展科研基金(2007-2003);北京市科技计划(D10100050010059)

摘　　要：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 explore the individualized treatment for vasovagal syncope （VVS） in children with different hemodynamic patterns. Methods A total of 63 children aged 6 - 19 years [mean age （11.57 ± 2.89） years] with VVS were followed up in clinics or by telephone. Totally 32 cases were diagnosed as VVS vasodepressor type, 31 cases were diagnosed as VVS mixed type or cardioinhibitory type. Fourteen cases took oral rehydration salts, 13 cases took metoprolol and 36 cases took midodrine hydroehloride as initial treatment. Patients were followed up for 3 - 48 months, with a mean of （21 ± 12） months. The recurrence of syncope in 3 months was studied to evaluate short-term efficacy of 3 different therapies. Taking recurrence of syncope as events, Kaplan-Meier curves were drawn to compare long-term efficacy of different therapies in treating VVS children. Results There was no statistical difference for the short-term efficacy among the diffrent hemodynemic patterns when treated with oral rehydration salts, or metoprolol or midodrine hydrochloride （oral rehydration ： X^2= 0.498, P 〉 0.05 ; metoprol ： X^2= 0.627, P 〉 0.05 ; midodrine hydrochloride ： X^ 2 = 2.057, P 〉 0.05）. There was no statistical difference for the long-term efficacy among VVS children with different hemodynamic patterns when treated with oral rehydration salts, or metoprolol. Patients with mixed or eardioin hibitory patterns had a better response than those with vasodepressor pattern to midodrine hydrochloride （P 〈 0.01） Conclusions Oral rehydration salts, metoprolol or midodrine hydrochloride are appropriate to treat children with VVS. Children with VVS mixed and cardioinhibitory patterns are more appropriate to take midodrine hydrochloride as initial treatment.

关 键 词：晕厥 血管迷走神经性 口服补液盐 美托洛尔 盐酸米多君 儿童 

分 类 号：R72[医药卫生—儿科]