儿童周期性呕吐综合征临床特征及预后随访  

Clinical features and prognosis and follow-up of cyclic vomiting syndrome in children

作　　者：蒋元媛 李中跃[1] JIANG Yuan-yuan;LI Zhong-yue(Department of Gastroenterology,Children's Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Chongqing Key Laboratoty of Pediatrics,Chongqing 400014 China)

机构地区：[1]重庆医科大学附属儿童医院消化科,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《中国实用儿科杂志》2021年第10期778-782,共5页Chinese Journal of Practical Pediatrics

摘　　要：目的分析儿童周期性呕吐综合征(CVS)临床表现、辅助检查、治疗及预后,以期提高对儿童周期性呕吐综合征的认识和诊治水平。方法回顾性分析重庆医科大学附属儿童医院消化科2008年1月至2019年12月住院且符合儿童功能性胃肠病ROMEⅣ诊断标准的141例CVS患儿临床资料及随访结果。结果 141例患儿中男65例、女76例,发病年龄中位数5.5岁(≤15岁5月龄),诊断年龄中位数8.3岁(11月龄至15岁8月龄),首次发病至确诊病程平均2.3年(3个月至11.3年),平均住院4次。其中60.28%(85/141)有明确诱因,感染与饮食不当最常见。所有病例均有呕吐,发作持续时间中位数为5 d(2~14 d),平均每日呕吐发作约15次,间歇期中位数38 d(5 d至6个月)。其他症状包括腹痛(72.34%,102/141)、恶心(46.81%,66/141)、头晕(30.50%,43/141)、发热(26.24%,37/141)、头痛(19.86%,28/141)、便秘(19.15%,27/141)。所有病例急性期均予以补液等对症支持治疗,发作间期予以赛庚啶、普萘洛尔、西比灵等药物预防治疗,88例随访1~10年,81例(92%)治疗有效,9例仍有头痛表现(其中1例外院诊断偏头痛),13例有腹痛表现。结论 CVS是儿童呕吐的常见病因之一,各年龄段均可发病,无明显性别差异,发作前通常有诱因且临床诊断常有延迟;CVS可反复发作,除呕吐外常有其他消化道或自主神经紊乱相关症状;对于发作频率高、持续时间长的患儿预防应用赛庚啶、普萘洛尔、西比灵等药物多数有效;该组CVS患儿流行病学、临床表现及疗效与其他地区相似,但随访偏头痛、腹痛发生率明显低于国外数据。Objective To analyze the clinical manifestations,lab findings,treatment and prognosis of children with cyclic vomiting syndrome(CVS) in order to improve the understancling and diagnosis and treatment level of cyclic vomiting syndrome. Methods Retrospectively analyze the clinical data and follow-up results of 141 children with CVS admitted to our hospital from January 2008 to December 2019 who met the ROME IV diagnostic criteria.Results Among the 141 children,65 were male and 76 were female.The median age at onset was 5.5 years(range:0-15.4 years),and the median age at diagnosis was 8.3 years(range:11 months-15.7 years).The average disease duration was 2.3 years(3 months-11.3 years),and the average hospitalization was 4 times.About 60.28%(85/141)of the patients had clear causes,and infection and improper diet were the most common.causes All cases had vomiting,and the median duration of each vomiting attack was 5 d(2 d-2 w),with an average of about 15 vomiting attacks per day and a median interval of 38 d(5 d-6 m).Other symptoms included abdominal pain(72.34%,102/141),nausea(46.81%,66/141),dizziness(30.50%,43/141),fever(26.24%,37/141),headache(19.86%,28/141),and constipation (19.15%,27/141).All cases were given symptomatic supportive treatment such as fluid supplementation in the acute phase,and prophylactic treatment such as cyproheptadine,propranolol and sibiline in the interphase.Follow-up was performed in 88 patientsfor 1-10 years,and the treatment was effective in 92% of the patients.Nine patients still had headaches(one of them was diagnosed with migraine in another hospital),and 13 patients had abdominal pain. Conclusion CVS is one of the common causes of vomiting in children.It can occur at all ages without obvious gender differences.There is usually an inducement before the attack and clinical diagnosis is often delayed.CVS can be recurrent,and in addition to vomiting,there are often other symptoms related to gastrointestinal or autonomic disorders.Cyproheptadine,propranolol,sibelium and other drugs are ef

关 键 词：儿童 周期性呕吐综合征 临床特征 预后 

分 类 号：R72[医药卫生—儿科]