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目的探讨不明原因晕厥患儿的诊断及各种血流动力学类型的变化规律。方法2000-05—2006-04,对在北京、湖南、湖北三地就诊或住院的208例不明原因晕厥或接近晕厥患儿[男87例,女121例;年龄3～19(11.66±2.72)岁],进行诊断学研究并对血流动力学类型进行检测,采用SPSS10.0软件进行统计。结果不明原因晕厥的患儿以女性居多,208例患儿中女性121例(58.2%),男性87例(41.8%);不明原因晕厥的患儿年龄近似正态分布,平均年龄11.66岁。208例不明原因晕厥患儿经直立倾斜试验(HUT)诊断,155例为阳性;基础直立倾斜试验(BHUT)的诊断阳性率达50.48%(105/208);舌下含化硝酸甘油激发的直立倾斜试验(SNHUT)的阳性率为74.52%(155/208),舌下含化硝酸甘油激发的直立倾斜试验的敏感度及诊断价值均为74.52%;在诊断为阳性的患儿中,体位性心动过速类型占60例(28.8%),血管抑制型72例(34.6%),心脏抑制型5例(2.4%),混合型18例(8.7%);53例经BHUT及SNHUT诊断为阴性的患儿,其血流动力学类型正常(25.5%)。不同年龄组(年龄<12岁和年龄≥12岁)间患儿性别比较差异无显著性(P>0.05);两组(年龄<12岁和年龄≥12岁)血流动力学类型分布差异有显著性(P<0.05);不同性别患儿血流动力学类型分布差异无显著性(P>0.05)。患儿主诉症状不同(主诉头晕、未晕倒和主诉晕厥发作)血流动力学类型分布差异有显著性(P<0.05);晕厥持续时间不同(持续时间≤5min和持续时间>5min)血流动力学类型分布差异无显著性;血流动力学类型不同,患儿的晕厥诱因、晕厥先兆、晕厥伴随症状及晕厥后状态不同。结论不明原因晕厥好发于女孩,并且高峰年龄接近12岁,直立倾斜试验对于此病的诊断阳性率较高;不同年龄段的患儿血流动力学类型分布不同。对于不明原因晕厥患儿,应采用HUT进行诊断并判断其血流动力学类型,以便于合理用药治疗。
Objective To investigate the diagnosis of children with unexplained syncope and the changes of various hemodynamic types. METHODS: Totally 208 unexplained fainted or near-fainted children (87 males and 121 females, aged 3-19 years (11.66 ± 2.72) years of age) with a doctor or hospitalized in Beijing, Hunan and Hubei from 2000-05-2006-04, Year-old], diagnostic studies and hemodynamic testing, using SPSS10.0 software for statistics. The results of unexplained syncope in children mostly women, 208 cases of children 121 cases (58.2%), 87 cases (41.8%); children with unexplained syncope of the approximate normal distribution of age, with an average age of 11.66 years. Of 208 children with unexplained syncope, diagnosed by upright tilt test (HUT) and 155 were positive, the positive rate of diagnosis of basal upright tilt test (BHUT) was 50.48% (105/208). The sublingual nitroglycerin-stimulated upright The positive rate of tilt test (SNHUT) was 74.52% (155/208). The sensitivities and diagnostic values of sublingual nitroglycerin upright tilt test were 74.52%. In diagnosed positive children, orthostatic Tachycardia accounted for 60 (28.8%), angiostatin type 72 (34.6%), cardiac inhibition type 5 (2.4%) and mixed type 18 (8.7%), and 53 were negative for BHUT and SNHUT Of children had normal hemodynamics (25.5%). There was no significant difference in gender among children of different ages (age <12 years and age> 12 years) (P> 0.05). The distribution of hemodynamics in both groups (age <12 years and age> 12 years) (P <0.05). There was no significant difference in the distribution of hemodynamics between children with different sex (P> 0.05). There were significant differences in the distribution of hemodynamics between the two groups (P <0.05); different duration of syncope (duration ≤5min and duration> 5min) There was no significant difference in the distribution of kinetic types. The types of hemodynamics were different. The causes of syncope, the precursor of syncope, the symptoms of syncope and the state of syncope were different in children. Conclusion unexplained syncope occurred in girls, and the peak age of nearly 12 years old, tilt test for the positive diagnosis of the disease is high; different age groups of children with different hemodynamic distribution. For children with unexplained syncope, HUT should be used to diagnose and determine the hemodynamic type, in order to facilitate rational drug treatment.