心率变异性对儿童血管迷走性晕厥的诊断价值  

Diagnostic Value of Heart Rate Variability in Vasovagal Syncope in Children

作　　者：王孟可 周彬[2] 吴杰斌[2] 王彦波 许慧 WANG Mengke;ZHOU Bin;WU Jiebin(Bengbu Medical College,Anhui 233030,China)

机构地区：[1]蚌埠医学院研究生院,233030 [2]徐州市中心医院儿科,221009

出　　处：《医学研究杂志》2022年第5期122-126,共5页Journal of Medical Research

基　　金：江苏省妇幼健康重点学科建设项目(FXK201743)。

摘　　要：目的通过测定血管迷走性晕厥(vasovagal syncope,VVS)儿童的心率变异性(heart rate variability,HRV),研究其对VVS儿童的诊断价值。方法选择2019年9月~2021年5月在徐州市中心医院儿童诊疗中心就诊的诊断为VVS的患儿,共60例,设为晕厥试验组,进行直立倾斜试验(head-up tilt table test,HUTT)和监测动态心电图,同时选取60例健康儿童为对照组,比较两组间HRV差异,以分析HRV对儿童VVS的诊断价值。结果60例VVS患儿中,阳性反应者共50例(83.3%),阴性反应者10例(16.7%),其中血管抑制型23例(37.1%),心脏抑制型10例(16.7%),混合型17例(28.3%)。试验组时域指标SDNNi、rMSSD显著升高,频域指标LF、HF、VLF显著升高,与对照组比较,差异有统计学意义。直立倾斜试验阳性组时域指标SDNNi、rMSSD明显升高,频域指标LF、HF、VLF显著升高,与阴性组比较,差异有统计学意义。SDNNi、rMSSD、LF、HF和VLF对HUTT诊断预测具有一定价值。分别以LF、HF和VLF,496、867.5和865.5作为界值时,对诊断阳性率的预测效果较好,敏感度分别为85%、62%和68%,特异性分别为63%、88%和84%。结论VVS患儿日常自主神经功能失衡,以增加的迷走神经活性为主,HRV对HUTT具有较好的预测诊断价值。Objective To study the diagnostic value of heart rate variability(HRV)in children with vasovagal syncope.Methods A total of 60 children with VVS diagnosed in the children′s diagnosis and treatment center of Xuzhou Central Hospital from September 2019 to may 2021 were selected as the syncope test group.Head up tilt table test(HUTT)and ambulatory electrocardiogram were performed.At the same time,60 healthy children were selected as the control group,and the differences of HRV between the two groups were compared to analyze the diagnostic value of HRV in children with VVS.Results Among the 60 cases of VVS,50 cases(83.3%)had positive reaction and 10 cases(16.7%)had negative reaction,including 23 cases of vascular inhibition type(37.1%),10 cases of cardiac inhibition type(16.7%)and 17 cases of mixed type(28.3%).The time domain indexes,SDNNi and rMSSD of the test group were significantly higher than those of the control group,and the frequency domain indexes LF,HF and VLF of the test group were significantly higher than those of the control group.The time domain indexes SDNNi and rMSSD in the positive group of head-up tilt test were significantly higher than those in the negative group,and the indexes of LF,HF and VLF in the frequency domain were significantly higher than those in the negative group.SDNNi,rMSSD,LF,HF and VLF had certain value in the diagnosis and prediction of HUTT.When the cutoff values of LF,HF and VLF were 496,867.5 and 865.5 respectively,the prediction effect of the positive rate of diagnosis was better,and the sensitivity was 92%,62%and 68%respectively,and the specificity was 60%,90%and 90%,respectively.Conclusion The daily autonomic nervous function of children with VVS is unbalanced,and the increased vagal activity is the main factor.HRV has a good predictive value for HUTT.

关 键 词：血管迷走性晕厥 心率变异性 直立倾斜试验 儿童 

分 类 号：R725.4[医药卫生—儿科]