儿童周期性呕吐综合征联合用药的治疗效果及临床特点随访  

Follow-up of children with cyclic vomiting syndrome:Combination therapy effects and clinical features

作　　者：郭姝[1] 官德秀[1] 梅天璐 于飞鸿[1] 周锦[1] 王国丽[1] 沈惠青[1] 张晶[1] 吴捷 徐樨巍[1] Guo Shu;Guan Dexiu;Mei Tianlu;Yu Feihong;Zhou Jin;Wang Guoli;Shen Huiqing;Zhang Jing;Wu Jie;Xu Xiwei(Department of Gastroenterology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院消化科,100045

出　　处：《中国小儿急救医学》2022年第2期99-103,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的了解联合用药治疗儿童周期性呕吐综合征(cyclic vomiting syndrome,CVS)的临床效果,以提高对儿童CVS的治疗水平。方法选择2012至2019年在首都医科大学附属北京儿童医院消化科诊断CVS的患儿为研究对象。治疗方案为A方案(赛庚啶+多赛平+丙戊酸),B方案(普萘洛尔+赛庚啶),C方案(普萘洛尔+阿米替林),服药时间≥3个月。共对42例患儿的临床资料进行回顾性分析,并对出院后的治疗效果进行随访,电话随访至2020年10月。结果42例患儿中,男17例,女25例,平均发病年龄(4.65±3.23)岁,诊断时年龄(6.79±3.58)岁。主要伴随临床症状包括腹痛、上消化道出血,42例均为中重度CVS。治疗方案:A方案7例,B方案11例,C方案24例。好转年龄(8.17±4.12)岁,服药疗程(1.37±0.96)年,随访时年龄(10.32±4.03)岁。至随访1年内,治疗有效35例,有效率为83.3%,其中完全无刻板样发作的呕吐23例,治疗无效共7例。三种治疗方案对CVS的治疗效果差异无统计学意义。治疗有效组与治疗无效组相比,个人史中有食管裂孔疝(P=0.024)、随访时体重(P=0.042)和服药疗程(P=0.020)差异有统计学意义。结论联合用药方案治疗CVS有效率较高,三种治疗方案对CVS的治疗效果无差异。对于联合用药治疗无效的难治性CVS患儿,需进一步制定个体化的治疗方案。Objective To compare the efficacy of combination therapy on cyclic vomiting syndrome(CVS)in children,and improve the efficacy of CVS treatment in the future.Methods This study retrospectively analyzed patients'medical records of CVS,which were admitted to Digestive Department of Beijing Children's Hospital from 2012 to 2019.The treatment regimen was A(Cyproheptadine+Doxepin+Valproate),B(Propranolol+Cyproheptadine),or C(Propranolol+Amitriptyline).Meanwhile,the patients should take drugs more than three months.The clinical data of 42 cases were analyzed retrospectively,and the treatment effect after discharge was followed up by telephone until October,2020.Results Among the 42 cases,17 were male and 25 were female,whose mean age of onset was(4.65±3.23)years,and the age of diagnosis was(6.79±3.58)years.The main accompanied symptoms were abdominal pain and upper gastrointestinal bleeding.Forty-two patients were moderate/severe CVS.The regimens A,B and C were observed in 7,11,and 24 patients,respectively.The age at improvement was(8.17±4.12)years.The course of treatment was(1.37±0.96)years.The age at follow-up was(10.32±4.03)years.During the 1-year follow-up,35 cases were effective,and the efficiency was 83.3%.Among them,23 cases had no paroxysmal vomiting and 7 cases had no effect.There was no significant difference in therapy effects among group A,B and C.Between the effective group and non-effective group,there were statistical differences in the personal history of hiatus hernia(P=0.024),the weight at follow-up(P=0.042),and the course of medication(P=0.020).Conclusion The combination regimen has a higher effective rate in the treatment of CVS.There was no significant difference among the three regimens in the treatment of CVS.For children with refractory CVS,who can not be treated with combination therapy,individualized therapy should be further developed.

关 键 词：周期性呕吐综合征 儿童 预防性治疗 随访 

分 类 号：R725.7[医药卫生—儿科]