儿童心源性晕厥98例临床分析及随访  

Clinical analysis and follow-up of 98 cases of cardiogenic syncope in children

作　　者：田芝瑜 高路 袁越 邵魏 Tian Zhiyu;Gao Lu;Yuan Yue;Shao Wei(Department of Cardiology,Heart Center,Beijing Children′s Hospital,Capital Medical University,National Children′s Medical Center,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心脏中心内科,100045

出　　处：《中国小儿急救医学》2023年第12期924-929,共6页Chinese Pediatric Emergency Medicine

摘　　要：目的回顾性分析儿童心源性晕厥(CS)的临床特征及随访情况,以准确、高效指导临床诊断及改善CS患儿预后。方法选取2016年4月1日至2023年6月31日于首都医科大学附属北京儿童医院心内科就诊并住院治疗的CS患儿98例为研究对象,依据病因类型分为心律失常组、器质性心血管疾病组及混合组。收集每组患儿晕厥发作的诱因、先兆症状类型、首诊时晕厥次数、意识丧失持续时间、伴随症状、既往史、家族史、体格检查及随访结果并进行统计学分析。结果共纳入98例CS患儿,男59例,女39例,首次发病年龄为(8.69±3.90)岁。心律失常组60例,器质性心血管疾病组18例,混合组20例。3组患儿在是否具有诱因、是否具有先兆症状、先兆症状类型发生率、意识丧失持续时间、尿便失禁及摔伤的伴随症状发生率、肝大发生率、随访有无复发晕厥方面差异均无统计学意义(P>0.05)。心律失常组比混合组更易因剧烈运动诱发晕厥(χ^(2)=9.785,P<0.05);相比于器质性心血管疾病组和混合组,心律失常组首诊时晕厥发作次数更多,≥5次更多(P<0.05);相比于器质性心血管疾病组,混合组和心律失常组晕厥发作时更易出现伴随症状(P<0.05),且均以抽搐发生率最高;混合组比心律失常组和器质性心血管疾病组更易出现心脏阳性体征(P<0.05);相比于心律失常组,混合组和器质性心血管疾病组更易存在面色发绀(P<0.05)。规律随访的87例CS患儿中,通过及时治疗及门诊规律调药之后,73例(83.9%)患儿未再复发晕厥。结论儿童CS具有特殊的临床特点,晕厥易由剧烈运动或情绪激动诱发,晕厥前常无发作先兆,意识丧失持续时间较短,晕厥主要伴随症状为抽搐,查体可见心脏阳性体征,既往史可有心脏疾病或家族史中有猝死;掌握其特点,并给予及时适当的处理,对提高儿童CS的诊断和改善预后具有重要意义。Objective To analyze the clinical features and follow-up of children with cardiogenic syncope(CS),and accurately and efficiently guide clinical diagnosis as well as improve the prognosis of children with CS.Methods Ninety-eight children with CS who were hospitalized in the Department of Cardiology,Beijing Children′s Hospital Affiliated to Capital Medical University from April 1,2016 to June 31,2023 were selected as the study objects.According to the etiology type,the children with CS were divided into arrhythmia group,organic cardiovascular disease group and mixed group.The causes of syncope episodes,type of aura,frequency of syncope at first diagnosis,duration of loss of consciousness,concomitant symptoms,past history,family history,physical examination and follow-up were collected and statistically analyzed in each group.Results A total of 98 children with CS were included,including 59 males and 39 females.The age of first onset was(8.69±3.90)years old.There were 60 cases in arrhythmia group,18 cases in organic cardiovascular disease group and 20 cases in mixed group.There were no statistically significant differences among three groups of children in whether had inducement,whether had aura,incidence of aura types,duration of loss of consciousness,incidence of urinary and fecal incontinence and associated symptoms of fall injury,incidence of liver macrosis,and recurrence of syncope during follow-up.The children in arrhythmia group were more likely to induce syncope due to intense exercise than those in mixed group(χ^(2)=9.785,P<0.05).Compared with the organic cardiovascular disease group and the mixed group,the number of syncope attacks in the arrhythmia group was more than five times at the first diagnosis(P=0.020).Compared with the organic cardiovascular disease group,the children in mixed group and arrhythmia group were more likely to have accompanying symptoms during syncope(P<0.05),and the incidences of convulsion were the higher in both groups.The positive signs of heart in mixed group were more than

关 键 词：心源性晕厥 儿童 临床特征 随访 

分 类 号：R725[医药卫生—儿科]