儿童神经介导性晕厥发作的昼夜节律  

The circadian rhythm of neurally mediated syncope in children

作　　者：廖冬磊 许毅[1] 邹润梅[1] 吴礼嘉[1] 罗雪梅[1] 李芳[1] 林萍[1] 王成[1] 

机构地区：[1]中南大学湘雅二医院儿童医学中心儿童心血管专科,中南大学儿科学研究所,长沙410011

出　　处：《中华实用儿科临床杂志》2016年第1期23-27,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：湖南省发展改革委员会课题[湘财企指（2015）83号]

摘　　要：目的探讨儿童神经介导性晕厥（NMS）发作的昼夜节律。方法选择2013年12月至2015年10月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的NMS患儿216例，男91例，女125例；年龄4-17（11．34±2．65）岁。根据直立倾斜试验（HUTF）结果分为血管迷走性晕厥（vvs）组和体位性心动过速综合征（POTS）组，其中VVS组178例，POTS组38例。216例NMS患者中〈12岁组[（8．88±1．88）岁]94例，≥12岁组[（13．24±1．18）岁]122例。在Hurrr前详细询问患者或监护人既往晕厥发作的次数及每次发作的时间段[将1d分为4个时间段：上午（06：00AM-12：00AM），下午（12：00AM-18：00PM），晚上（18：00PM-24：00PM），夜间（00：00AM-06：00AM）]。结果1．一般资料：216例患儿中晕厥发作总次数614次。其中VVS组178例，晕厥总次数471次；POTS组38例，晕厥总次数143次。VVS组与POTS组晕厥发生节律未见性别及年龄差异（P〉0．05）。2．VVS组晕厥发作频次在上午较下午、晚上及夜间明显增加（P〈0．05）；POTS组晕厥发作频次在各时间段差异无统计学意义（P〉0．05）；VVS组在上午发生晕厥的比例高于POTS组，在晚上发生晕厥的比例低于POTS组（P〈0．05）。3．NMS男童在上午发生晕厥的比例较女童高（X^2=11．001，P=0．012）。4．〈12岁组（94例，273次）与≥12岁组（122例，341次）在1d内各时间段晕厥发作频次差异无统计学意义（X^2=1．995，P=0．573）。结论VVS患儿晕厥发作存在昼夜节律，晕厥频次在上午最多，但POTS患儿晕厥发作未表现出明显的昼夜节律。NMS男童在上午发生晕厥的比例较女童高。Objective To explore the circadian rhythm of neurally mediated syncope （NMS） in children Methods There were 216 children with NMS included in the study, including 91 male and 125 female, aged from 4 to 17 years old with a mean age of （11.34 ± 2.65）years,who came from the Specialist Syncope Outpatient Department or Inpatient Department of the Second Xiangya Hospital of Central South University from Deeember 2013 to October 2015. The patients were divided into vasovagal syncope （VVS） group and postural tachycardia syndrome （POTS） group ac- cording to head -up tilt test （HUTF） results, including 178 VVS patients and 38 POTS patients. Ninety -four patients with NMS were in the 〈 12 years old group[ （8.88 ± 1.88）years old] and 122 subjects with NMS were in the ≥ 12 years old group[ （ 13.24 ± 1. 18 ） years old]. All patients or guardians were carefully asked about the number of synco- pal attacks and the periods in which episodes occurred in before HUTT [ 24 hours of a day were divided into 4 periods ： morning （06 ： 00 AM -12 ： 00 AM） ,afternoon （12 ： 00 AM -18 ： 00 PM） ,evening （18 ： 00 PM -24 ：00 PM）, night （00 ： 00 AM - 06 ： 00 AM ） 1. Results （ 1 ） General data： the total syncopal episodes of 216 children with NMS were 614 episodes, including 178 VVS patients with 471 syncopal episodes in total and 143 attacks of 38 children with POTS. There were 273 episodes of 94 patients in the 〈 12 years old group and 341 episodes of 122 subjects in the 〉112 years old group. There were no significant differences in the diurnal variation of syncopal episodes between the VVS group and POTS group regarding age and gender （ P 〉 0. 05 ）. （2） The number of syncopal episodes in patients with VVS which occurred in the morning hours was strikingly higher than that of afternoon, evening or nighttime （ P 〈 0.05 ）. But there was no significant difference in the frequency of episodes in different periods through the day in the POTS group （ P 〉

关 键 词：晕厥 昼夜节律 神经介导性 儿童 

分 类 号：R725.4[医药卫生—儿科]