106例儿童一过性意识丧失的病因及临床特征  

Causes and clinical features of transient loss of consciousness in 106 children

作　　者：刘慧[1] 李章勇[1] 张蕾[1] 刘晓燕[1] 

机构地区：[1]重庆医科大学附属儿童医院心血管内科,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆400014

出　　处：《第三军医大学学报》2015年第1期74-77,共4页Journal of Third Military Medical University

基　　金："十二五"国家科技支撑计划(2012BAI03B03);重庆市自然科学基金(CSTC2010BB5373)~~

摘　　要：目的探讨小儿一过性意识丧失(transient loss of consciousness,TLOC)的病因、临床特征及鉴别诊断。方法收集2013年1月至2014年3月在重庆医科大学附属儿童医院门诊就诊或住院的106例TLOC患儿的临床资料,对其病因及临床特征进行分析总结。结果 106例患儿中,晕厥型89例(84.0%),非晕厥型17例(16.0%)。在晕厥型中,直立不耐受(orthostatic intolerance,OI)42例(39.6%),心源性晕厥(cardiac syncope,CS)16例(15.1%),境遇性晕厥1例(0.9%),不明原因晕厥30例(28.3%);在非晕厥型中,神经源性疾病5例(4.7%),心因性疾病10例(9.4%),代谢性疾病2例(1.9%)。92.9%(39/42)的OI有诱因及先兆,59.5%(25/42)意识丧失<1 min,26.2%(11/42)存在晕厥家族史。CS起病急剧,56.3%(9/16)CS在劳累时诱发,100%(16/16)心电图异常,住院期间死亡3例。10例心因性疾病中8例有明确的诱因,7例意识丧失>10 min。结论 OI是儿童TLOC最常见病因,具有明显临床特征,诊断过程中首先需排除CS,其次应注意与心因性假性晕厥及癫痫相鉴别。Objective To investigate the causes, clinical features and differential diagnosis of children transient loss of consciousness （TLOC）. Methods A total of 106 children with TLOC were collected from the outpatient or inpatient department of our hospital from January 2013 to March 2014. And their etiology and clinical features were analyzed. Results In the cohort, 89 cases （84.0%） were syncope and the other 17 （ 16.0% ） were non-syncope. Among the syncope cases, 42 （ 39.6% ） were orthostatic intolerance （OI）, 16 （15.1% ） cardiac syncope （CS）, and 1 （0.9%） situational syncope, while the other 30 cases （28. 3% ） had no explanation. For these non-syncope children, 5 （4. 7% ） had neurogenic diseases, 10 （9.4%） had psychogenic pseudo-syncope, and 2 （ 1.9% ） had metabolic disorders. In the 42 OI patients, 39 （92.9%） had inducement and pre-syncope, 25 （59.5%） had loss of consciousness within 1 min, and 11 （26.2%） had family history. CS often occurred with sudden onset. Exertion related syncope spells were found in 9 cases （56.3%, 9/16 ）. All CS （100%, 16/16 ） patients had abnormal electrocardiograms, and 3 of them died in hospital. In 10 children of psychogenic pseudo-syncope, definite inducement was found in 8 patients （ 80.0% ）, and 7 （70.0%） had loss of consciousness beyond 10 min. Gonclusion OI is the most common cause for TLOC in children, with manifested clinical signs and symptoms. OI should be differentiated with CS firstly, while psychogenic pseudo-syncope and epilepsy should also be differentiated.

关 键 词：儿童 一过性意识丧失 病因 临床特征 

分 类 号：R729[医药卫生—儿科] R741.041[医药卫生—临床医学]