儿童晕厥诊断和治疗进展  

Progress in diagnosis and management of syncope in children

作　　者：徐文瑞[1] 廖莹[1] 金红芳[1] 张清友[1] 唐朝枢[2] 杜军保[1] XU Wen - rui;LIAO Ying;JIN Hong-fang;ZHANG Qing-you;TANG Chao-shu;DU Jun-bao(Department of Pediatrics, Peking University First Hospital, Beijing 100034, China;Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Beijing 100191, China)

机构地区：[1]北京大学第一医院儿科,北京100034 [2]北京大学基础医学院生理学与病理生理学系,北京100191

出　　处：《北京大学学报（医学版）》2017年第5期756-759,共4页Journal of Peking University:Health Sciences

基　　金：国家十二五科技支撑计划(2012BA103B03);首都医学发展基金重点支持项目(2007-2003);首都医学发展基金自主创新项目(2002-3037);首都临床特色应用研究(Z121107001012051;D10100050010059);首都十大危险疾病科技成果推广专项(Z11110006140000);北京市科技计划课题(Z171100001017253)资助~~

摘　　要：晕厥是由于一过性脑供血减少或中断导致的临床急症，主要表现为一过性意识丧失，伴有肌张力丧失、自主体位不能维持而摔倒，过程多为短暂性、自限性。儿童晕厥在儿童及青少年时期常见，约15%的儿童及青少年至少经历一次晕厥发作，严重影响患儿的生活质量[1<。既往大部分导致晕厥的基础疾病不能明确诊断，近年来由于导致晕厥的基础疾病的不断被发现，诊治方法不断优化和创新，因此儿童晕厥的诊断率和治愈率有了很大提高。Syncope is a comm o n emergency of children and adolescents,which has serious influence on the quality of life.Neurally-mediated syncope,including postural tachycardia syndrome,vasovagal syncope,orthostatic hypotension and orthostatic hypertension,is the main cause of syncope in children and adolescents.The main manifestations of neurally-mediated syncope are diverse,such as dizziness,headache,chest tightness,chest pain,pale complexion,fatigue,pre-syncope and syncope.Although the clinical manifestations are similar,each subtype of syncope has its hemodynamic feature and optimal treatment option.The diagnosis rate of syncope in children has been greatly improved on account of the development of the diagnostic procedures and methods.In recent years,with the promotion of head-up tilt test and drug-provocated head-up tilt test,the hemodynamic classification of neurally-mediated syncope gets continually refined.In recent years,with the effort of clinicians,an appropriate diagnostic protocol for children with syncope has been established.The initial evaluation consists of history taking,physical examination,standing test and standard electrocardiography.After the initial evaluation,some patients could be diagnosed definitely,such as postural tachycardia syndrome,orthostatic hypotension,and situational syncope.Those with a specific entity causing syncope need selective clinical and laboratory investigations.Patients for w h o m the cause of syncope remained undetermined should undergo head-up tilt test.The precise pathogenesis of neurally-mediated syncope is not entirely clear.In recent years,studies have shown that neurally-mediated syncope may be related to several factors,including hypovolemia,high catecholamine status,abnormal local vascular tension,decreased skeletal muscle p u m p activity and abnormal neurohumoral factors.Currently based on the possible pathogenesis,the individualized treatment of neurally-mediated syncope has also been studied in-depth.Generally,the management of neurallymediated syncope include

关 键 词：儿童晕厥 诊断流程 治疗 

分 类 号：R725.4[医药卫生—儿科]