口服补液盐[I]对不同血流动力学类型神经介导性晕厥儿童的疗效评估  

Therapeutic effect evaluation of oral rehydration salts [ I ] on autonomic nerve mediated syncope in children with different hemodynamic patterns

作　　者：刘晓燕[1,2] 王成[1] 吴礼嘉[1] 林萍[1] 李芳[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 [2]长沙市中心医院儿科,410004

出　　处：《中华实用儿科临床杂志》2017年第1期26-29,共4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];湖南省自然科学基金（2016JJ2167）

摘　　要：目的评价口服补液盐[Ⅰ]对不同血流动力学类型儿童神经介导性晕厥（NMS）的疗效。方法对2012年3月至2015年2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不明原因晕厥或晕厥先兆儿童，经直立倾斜试验（HUTT）检查阳性诊断为NMS 105例，年龄4～18岁，平均（11.96±2.86）岁。其中血管迷走性晕厥（VVS）73例（血管抑制型46例、混合型和心脏抑制型共27例），体位性心动过速综合征（POTS）32例。采用简单随机化分组方法分为口服补液盐[Ⅰ]＋健康教育组55例，单纯健康教育组50例。对所有接受治疗的患儿进行随访。随访时间为6～25（14.82±6.13）个月，根据停药后6个月内临床症状复发情况及复查HUTT结果评价短期疗效；以晕厥或晕厥先兆复发为终点事件，作Kaplan-Meier曲线，比较2组NMS患儿的长期疗效。结果短期疗效：2种治疗措施对血管抑制型VVS、混合型及心脏抑制型VVS、POTS组的主观有效率和HUTT转阴率差异均无统计学意义（均P〉0.05）。长期疗效：与单纯健康教育组比较，接受口服补液盐[Ⅰ]治疗后累积有效率更高，差异有统计学意义（74.5%比52.0%，χ^2＝14.424，P〈0.01）。在接受口服补液盐[Ⅰ]治疗者中，血管抑制型VVS的累积有效率高于混合型和心脏抑制型VVS，差异有统计学意义（90.0%比61.1%，χ^2＝4.435，P〈0.05）。结论与混合型及心脏抑制型VVS相比，口服补液盐[Ⅰ]更适于血管抑制型VVS患儿。Objective To explore the effects of oral rehydration salts [ I ] （ORS I ） for autonomic nerve mediated syncope（NMS） in children with different hemodynamic patterns. Methods A total of 105 patients with unexplained syncope and prodromal symptoms of syncope who were confirmed as NMS by head - up tilt table test（HUTT） and treated in the Department of Pediatric Cardiovasology, Children＇s Medical Center, the Second Xiangya Hospital, Central South University,from March 2012 to February 2015. Their ages were from 4 to 18 years old,the average age was （ 11.96 ± 2.86） years old. Totally 73 cases were diagnosed as vasovagal syncope （VVS） （46 cases were vasodepressor type ,27 cases were VVS mixed type or cardioinhibitory type）, while 32 cases were diagnosed as postural orthostatic tachycardia syndrome（POTS）. Simple random method was used to divide them into conventional therapy （health education and tilt training） plus ORS I group （55 cases）, and conventional therapy group （50 cases）. Patients were followed up for 6 - 25 （ 14.82 ±6.13 ） months. The recurrence of syncope and review of HUTr outcome assessment in 6 months, treatment was studied to evaluate short - term efficacy of 2 different therapies for NMS in children with different hemodynamic patterns. Taking recurrence of syncope as outcome events, Kaplan - Meier curves were drawn to compare long - term efficacy of different therapies in treating NMS children. Results There was no statistical difference in the short - term efficacy among the different hemodynamic patterns when treated with conventional therapy plus ORS I, or conventional therapy（ all P 〉 0.05 ）. The cumulative efficiency of the conventional therapy plus ORS I was superior to that of the conventional therapy for NMS children through the long - term follow - up study （74.5% vs. 52.0% ,χ^2 = 14. 424, P 〈 0.01 ）. Patients with vasodepressor patterns had a better response than those with mixed or cardioinhibitory patterns to conventional therapy pl

关 键 词：神经介导性晕厥 口服补液盐 儿童 

分 类 号：R725.4[医药卫生—儿科]