自主神经功能检测对体位性心动过速综合征的诊断价值  

Diagnostic Value of Autonomic Nerve Function Tests for Postural Orthastatic Tachycardia Syndrome

作　　者：朱露璐[1] 张凤文[1] 张清友[1] 金红芳[1] 杜军保[1,2] 

机构地区：[1]北京大学第一医院儿科,北京100034 [2]教育部分子心血管学重点实验室,北京100191

出　　处：《实用儿科临床杂志》2011年第9期684-686,共3页Journal of Applied Clinical Pediatrics

基　　金：首都医学发展科研基金(2007-2003)

摘　　要：目的探讨自主神经功能检测对体位性心动过速综合征(POTS)的诊断价值。方法对POTS患儿26例和健康儿童20例分别测定其瓦式(Valsalva)比值、深呼吸心率差、30 s最长RR间期/15 s最短RR间期(30/15)比值、卧立位血压差等自主神经功能及12导联同步体表心电图(12 ECG)QT间期离散度(QTd)、P波离散度(Pd)水平的变化。采用SPSS 13.0软件进行统计学分析。结果 POTS患儿Valsalva比值、深呼吸心率差与健康对照组比较[Valsalva比值:(1.08±0.06)vs(1.22±0.03);深呼吸心率差:(9.7±1.7)次.min-1 vs(18.3±1.6)次.m in-1]均明显降低,差异均有统计学意义(t=5.86、11.34,Pa<0.05)。与健康对照组比较,POTS患儿最大QT间期(QTmax)、最小QT间期(QTmin)、QTd延长(Pa<0.01),心率校正后最大QT间期(QTcmax)、心率校正后QT间期离散度(QTcd)增大(Pa<0.01,<0.05),而心率校正后最小QT间期(QTcm in)二组比较无统计学差异;二组最大P波时间(Pmax)、最小P波时间(Pm in)、心率校正后最大P波(Pcmax)、心率核正后最小P波(Pcm in)、Pd及心率校正后P波离散度(Pcd)比较,差异均无统计学意义(Pa>0.05)。结论 POTS患儿自主神经明显受损,Valsalva比值、深呼吸心率差、QTd可作为诊断POTS的一种新方法。Objective To explore the diagnostic value of autonomic nerve function tests for children with postural orthastatic tachycardia syndrome（POTS）.Methods Cardiovascular autonomic nerve function tests,including response index of Valsalva maneuver,heart rate change with deep respiration,3015 postural ratio,postural change of blood pressure,the variation of QT interval dispersion（QTd） and P-wave dispersion（Pd） of 12-lead simultaneous body surface electrocardiogram were performed in POTS group including 26 cases of POTS and healthy control group including 20 cases of healthy children.The data were analyzed by SPSS 13.0 software.Results Index of Valsalva maneuver ratio and heart rate change with deep respiration of POTS children were significantly lower than those of healthy subjects [Valsalva maneuver index：（1.08±0.06） vs（1.22±0.03）;heart rate change with deep respiration：（9.7±1.7） times per min vs（18.3±1.6） times per min,Pa0.05].In addition,compared with the healthy control group,maximal QT interval（QTmax）,minimal QT interval（QTmin） and QTd prolonged（Pa0.01）,maximal QT corrected for heart rate（QTcmax） and QT interval disperision corrected for heart rate（QTcd） were increased（P0.01,0.05）.There were no significant differences in maximal P wave（Pmax）,minimal P wave（Pmin）,maximal P wave corrected for heart rate（Pcmax）,minimal P wave corrected for heart rate（Pcmin）,QTcmin,Pd and P wave dispersion corrected for heart rate（Pcd） between the 2 groups（Pa0.05）.Conclusions POTS children showed a significant impaired autonomic nervous function.Index of Valsalva maneuver,heart rate change with deep respiration and QTd can be used as a new diagnostic method of POTS.

关 键 词：体位性心动过速综合征 自主神经功能 儿童 

分 类 号：R725.4[医药卫生—儿科]