盐酸米多君对儿童血管迷走性晕厥的干预效果

目的 探讨盐酸米多君对儿童血管迷走性晕厥(VVS)的干预效果.方法 2007年4月至2008年10月在中南大学湘雅二医院儿童晕厥专科就诊或住院的6～17(11±3)岁48例不明原因晕厥或晕厥先兆、直立倾斜试验(HUTT)阳性的VVS患儿,分健康教育组(n=10)、口服补液盐组(n=23)、盐酸米多君组(n=15)3组,根据HUTT结果评价疗效.治疗6个月后,如没有晕厥或晕厥先兆发作则停药并继续随访,评价患儿晕厥及晕厥先兆复发率、药物不良反应及干预前后血流动力学变化.数据统计用SPSS 11.5软件.结果 ①HUTT总转阴率在健康教育组、口服补液盐组及盐酸米多君组分别为20.0%(2/10)、60.9%(14/23)及80.0%(12/15),其中盐酸米多君组及口服补液盐组均明显高于健康教育组(均P<0.05),盐酸米多君组及口服补液盐组差异无统计学意义(P>0.05).②随访6～12个月,晕厥及晕厥先兆复发率在健康教育组、口服补液盐组、盐酸米多君组分别为60.0%(6/10)、52.2%(12/23)及13.3%(2/15),盐酸米多君组明显低于前两组(P<0.05),健康教育组和口服补液盐组差异无统计学意义(P>0.05).③3组在干预前、后平卧位血压和心率差异无统计学意义(P>0.05);盐酸米多君组干预后心率及血压差值在倾斜起始较基础平卧位显著缩小(均P<0.05).结论 健康教育和补液补盐是治疗VVS儿童的基本措施,盐酸米多君能增加其干预效果,且安全有效.

Efficacy of mkdodrine hydrochloride in the treatment of children with vasovagal syncope

Objective To explore the efficacy of midodrine hydrochloride in the treatment of vasovagai syncope (VVS) in children. Methods Forty-eight children with unexplained syncope mid prodromata (21 males ,27 females, aged 6 - 17 years, mean 11 years±3 years) were randomly assigned into 3 groups. They were health education group, oresol group mid midodrine hydrochloride group respectively. Oresol group was comprised of children given oresol as first-line therapy in addition to health education and midodrine hydrochloride group patients given midadrine hydrochloride on the basis of oresol group. Repeated head-up tilt testing (HUTT) and follow-ups of at least 6 months were conducted to evaluate the therapeutic efficacy, side effects of midodrine hydrochloride and hemodyuamic changes in treating pediatric VVS. (12/15) respectively. It was significantly higher in cases of midedrine hydrochloride group mid oresol group than that of health education group (P <0.05). However,there was no significant difference in the HUTT- follow-up period, the recurrence rate of syncope was significantly lower in midodrine hydrochloride group than in'other two groups (P <0.05). However, there was no significant difference in the recurrence rate of supine hemodynamic indices (HR, SBP, DBP) between before and after treatment in 3 groups. After midedrine therapy, the effects of midodrine upon changes in systolic and diastolic pressures and heart rate, between upright beginning and supine positions, were statistically significant (P < 0.05). Conclusion Health education and oresol are conventional therapies for pediatric VVS. The efficacy can be enhanced by supplementing midodrine hydrochloride. Such a regimen is effective and safe in treating pediatric VVS.