心脏变时性功能在血管迷走性晕厥患儿中的临床意义  

Clinical value of chronotropic competence in children with vasovagal syncope

作　　者：张清友[1] 刘艳霞[2] 廖莹[1] 杜军保[1] ZHANG Qing-you;LIU Yah-xia;LIAO Ying(Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院儿科,北京100034 [2]北京市怀柔区妇幼保健院儿科,北京101400

出　　处：《中国实用儿科杂志》2018年第11期877-880,903,共5页Chinese Journal of Practical Pediatrics

摘　　要：目的研究血管迷走性晕厥(vasovagal syncope,VVS)患儿的心脏变时性功能变化及其临床意义。方法回顾性分析2011年3月至2017年1月在北京大学第一医院儿科39例不明原因晕厥患儿的临床资料。经详细病史询问及辅助检查,28例患儿确诊为VVS,其中血管抑制型15例,混合型9例,心脏抑制型4例,11例为不明原因晕厥患儿,比较VVS患儿与不明原因晕厥患儿及不同血流动力学类型的VVS患儿之间的一般情况及运动平板试验时心率变化及心脏变时功能等情况。进一步根据VVS患儿心脏变时性功能情况分为变时性功能正常组(10例)及变时性功能不全(chronotropic incompetence,CI)组(17例,1例患儿失访),通过随访2组患儿晕厥复发情况,观察心脏CI对VVS患儿预后的影响。结果 VVS患儿与不明原因晕厥患儿相比较,人口学指标均无显著性差异,在运动平板试验中VVS患儿运动时最快心率及心脏变时性指数显著低于不明原因晕厥患儿(P<0.05),VVS患儿的CI发生率显著高于不明原因晕厥患儿(64.3%vs. 27.3%,P<0.05)。不同血流动力学类型的VVS患儿比较,心脏抑制型及混合型患儿CI的发生率显著高于血管抑制型患儿。通过对27例VVS患儿随访发现,伴有CI的VVS患儿晕厥的复发率显著高于不伴有CI的患儿(P<0.05),以患儿晕厥复发的时间作为随访终点对VVS患儿进行生存分析,有CI的VVS患儿较无CI的患儿对治疗的反应不佳(Log-rank:P=0.028)。结论心脏变时性功能在VVS患儿中有显著的改变,尤其常见于心脏抑制型和混合型患儿。伴有CI的VVS患儿对治疗的反应不佳。Objective To evaluate the chronotropic competence in children with vasovagal syncope（VVS）. Methods Thirty-nine patients（17 males,22 females,age ranging from 8-16 years）with syncope were included in the study,and28 were diagnosed with VVS,including 15 cases of vasodepressor type,9 cases of mixed type,and 4 cases of cardioinhibitory type;11 were with unexplained cause of syncope. A treadmill test was performed and heart-rate response during exercise was evaluated by the chronotropic reserve. Demographic data and change of heart rate,blood pressure during test and CRI were compared between the 2 groups and different types of VVS. Furthermore,based on CRI,patients with VVS were divided into the normal chrontropic group（n=10）and CI group（n=17）. By following the recurrence of syncope of2 groups,the effect of CI on the prognosis of VVS in children was observed. Results There were no significant differences between children with VVS and with unexplained syncope in sex,age,BMI,baseline heart rate,MaxMET or baseline blood pressure. But during exercise test,peak heart rate and CRI were significantly lower in children with VVS than in unexplained syncope. The incidence of CI in children with VVS was significantly higher than that in children with unexplained syncope（64.3% vs. 27.3%,P〈0.05）. The incidence of CI in VVS with vasodepressor-type in children was significantly lower than those with cardioinhibitory-type and mixed-type. During following-up period,the recurrence rate of syncope in VVS children with CI was significantly higher than that of children without CI. Patients with CI had significantly worse prognosis compared to those without CI（Log-rank：P=0.028）. Conclusion Chrontropic competence is significantly altered in children with VVS,especially in cardioinhibitory-type and mixed-type in children. CI is the significant predictor for poor prognosis in children with VVS.

关 键 词：血管迷走性晕厥 心脏变时性功能 运动平板试验 自主神经功能 

分 类 号：R72[医药卫生—儿科]