儿童直立性低血压的年龄和性别差异

目的探讨儿童直立性低血压(OH)的性别和年龄差异。方法选取2000年1月-2010年5月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的不明原因晕厥、头痛、头晕的患儿1 158例。年龄3.1～17.0(10.72±2.80)岁;男597例,女561例。经直立倾斜试验(HUTT)诊断为OH的患儿45例。将45例OH患儿分为≥12岁组与<12岁组,分析2组HUTT的阳性率、OH病程、平卧后站立位3 min内舒张压及收缩压下降量的年龄和性别差异。结果 1.HUTT阳性率为3.88%(45/1 158例),男女间HUTT阳性率比较差异无统计学意义(χ2=0.584,P>0.05),≥12岁组与<12岁组比较差异无统计学意义(χ2=0.631,P>0.05)。2.病程:<12岁组病程为0.03～60.00(8.13±14.06)个月,男女比较差异无统计学意义[(4.77±7.86)个月vs(10.59±17.10)个月;t=0.634,P>0.05];≥12岁组OH病程为0.30～72.00(20.10±22.20)个月,男女比较差异无统计学意义[(16.55±1.80)个月vs(26.03±2.87)个月;t=0.273,P>0.05]。<12岁组与≥12岁组病程比较差异无统计学意义[(8.73±16.07)个月vs(20.11±22.20)个月,t=1.932,P>0.05]。3.血压下降量:HUTT 3 min内收缩压和舒张压的下降量在<12岁组与≥12岁组间差异无统计学意义(t=1.495、0.079,Pa>0.05),<12岁组男女间差异无统计学意义(t=0.019、1.730,Pa>0.05),≥12岁组男女间比较差异无统计学意义(t=0.364、0.843,Pa>0.05)。结论 OH的诊断率、病程、3 min血压下降量在儿童不存在年龄和性别差异。     

口服补液盐治疗儿童直立性低血压的疗效评价

目的 探讨口服补液盐(ORS)治疗儿童直立性低血压(OH)的疗效.方法 选取2009年10月至2012年1月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的不明原因晕厥或先兆晕厥且行直立倾斜试验(HUTT)诊断为OH的患儿12例.男5例,女7例;年龄6～14岁[(10.25±2.86)岁].予ORS治疗14 ～493 d[(74.50±134.43) d]后随诊复查HUTT.采用SPSS 16.0软件进行统计学分析.结果 1.血流动力学变化:HUTT开始前平卧位时心率(HR0)、HUTT开始后3 min时心率(HR3)、HUTT开始前平卧位时收缩压(SBP0)、HUTT开始后3 min时收缩压(SBP3)、HUTT开始前平卧位时舒张压(DBP0)治疗前后比较差异均无统计学意义(P均＞0.05),HUTT开始后3 min舒张压(DBP3)治疗后较治疗前明显升高[(68.42±7.01)mm Hg(1 mm Hg=0.133 kPa)比(57.83±13.98) mmHg,t=-2.344,P＜0.05].复查HUTT时OH儿童晕厥、先兆晕厥等症状减轻5例,消失7例.2.血流动力学变化的性别比较:治疗前及治疗后HR0、HR3、SBP0、SBP3、DBP0、DBP3男女比较差异均无统计学意义(P均＞0.05).结论 ORS能明显提高OH患儿舒张压,改善直立不耐受症状.     

直立性低血压研究进展

直立性低血压是人体从卧位转为站立时静脉回心血量减少,脑血流暂时缺血所引起的一系列临床症状,主要表现为体位改变时血压下降从而出现头晕、晕厥等,对人们的日常生活以及工作等造成不良影响.     

儿童直立性高血压

直立性高血压(OHT)在临床多见,但认识欠深入,目前尚缺乏统一的诊断标准.其发病机制与交感神经系统过度兴奋、血管肾上腺素高度敏感、压力反射感受器反射异常等有关.OHT多见于老年人,自主神经功能失调的儿童发病率也较高,可导致慢性肾损害、心脑血管疾病,并与糖尿病周围神经病变、无症状性脑梗死等密切相关,可作为预测高血压、糖尿病、蛋白尿和肾脏疾病及未来自主功能障碍的筛选工具、高血压靶器官损伤的长期评估指标.目前尚缺乏针对性治疗措施及有效降低其患病率和病死率的方案.     

直立倾斜试验对儿童血管迷走性晕厥的诊断价值

晕厥是临床常见的病症,常规进行的心脏及神经系统检查均正常,故称之为不明原因的晕厥,其中血管迷走神经性晕厥为最常见的病因,以往缺乏有效的实验室检查方法,近年国外Fitzpatriek等应用直立倾斜试验,能有效地诱发易感患儿的血管迷走性晕厥发作,已有相继报道。但国内儿科罕见报道。我们应用直立倾斜试验对45例不明原因晕厥患儿进行研究,以探讨其诊断价值。     

直立倾斜试验在儿童血管迷走性晕厥中的诊断价值

目的：探讨直立倾斜试验儿童血管迷走性晕厥的诊断价值。方法：对24例不明原因晕厥的患儿进行基础直立倾斜试验，并以12名正常儿童作对照，在倾斜过程中动态观察心电图、血压、心率，并进行分析。结果：24例晕厥患儿中，基础直立倾斜试验阳性16例，而对照组为0.诊断敏感度为67%,特异度为100%,诊断价值为78%.16例阳性反应中，心脏抑制型反应3例（19%），表现为心动过缓，血压无变化；血管抑制型反应9例（56%），表现为血压下降，心率加快；混合型反应4例（25%），表现为心率、血压均有明显下降。结论：基础直立倾斜试验可作为儿童血管迷走性晕厥的一种重要诊断方法。     

儿童直立不耐受的诊断及治疗

一、概述直立不耐受(orthostatic intole_rance,OI)系多因直立而发生的一系列临床症状,平卧后症状缓解。对于“直立不耐受”这个术语在临床中有时会有一些误解,有人认为只有在身体直立时才会出现心率及血压的异常,因而导致患者出现症状。事实上,这些异常表现通常出现在直立体位,但也可发生在其他体位[1]。OI通常分为急性OI和慢性OI。急性OI表现为晕厥,即因脑血流灌注减少引起的短暂意识及肌张力的丧失,不能维持站立体位。慢性OI的症状主要有:经常发生的头晕、疲乏、视物模糊、眼前发黑、心悸、胸闷等。大部分患儿同时伴有头痛、发抖、…     

儿童直立倾斜试验

<正>直立倾斜试验(head-uptilt test,HUTT)是通过改变被检查者的体位(从平卧位改变至一定角度的倾斜位),再现其晕厥发作过程的一种检查方法。20世纪80年代末     

儿童血管迷走性晕厥直立倾斜试验中心电图的变化

目的 探讨儿童血管迷走性晕厥(VVS)直立倾斜试验(HUTT)中ECG的变化.方法 选取本院门诊及住院晕厥患儿123例,经详细询问患儿病史,行体格检查、常规12导联ECG及头颅CT等一系列检查,疑诊VVS 65例.疑诊VVS患儿停用可能影响自主神经功能的饮食,停用血管活性药物5个半寿期以上(6～8 d),行HUTT或舌下含化硝酸甘油倾斜试验.结果 VVS患儿HUTT中可出现各种心律失常,以窦性心动过速多见[40例(61.5%)],结性逸搏心律次之[23例(35.4%)].HUTT阳性类型:血管抑制型45例(69.2%),混合型16例(24.6%),心脏抑制型41例(6.2%).结论 VVS儿童HUTT中可出现各种心律失常.VVS患儿应严密观察ECG变化,必要时积极干预,以免发生意外.     

儿童直立不耐受研究进展

<正>直立不耐受(orthostatic intolerance,OI)是指因直立而发生的一系列症状,当平卧后症状可以缓解。然而,广义上讲,这些症状可以见于任何体位[1]。急性直立不耐受通常表现为晕厥,即因急性脑血流灌注不良引起的短暂意识丧失和肌张力丧失,不能维持站立体位而跌倒,有时也可     

儿童低颅压综合征的诊断与急救处理

儿童低颅压综合征是容易被忽视的问题,但临床上确实时有发生,应该引起广大医务工作者的注意.原发性低颅压综合征多与自身脑血管功能障碍、感染有关;继发性低颅压综合征多与医源性、继发于其他疾病以及外伤有关.低颅压综合征的主要临床症状是体位相关性头痛,一般通过脑脊液测压即可诊断.多数患儿经过体位调整后临床症状消失,重者可通过饮水、静脉滴注低渗(0.5％)或生理盐水给予纠正.儿童低颅压综合征重在预防,预后良好.     

直立不耐受患儿家长对疾病认识和需求的调查研究

目的了解直立不耐受患儿家长对疾病的认识和需求,旨在有针对性地为患儿及其家长提供健康教育和情感支持。方法对2005年10月～2006年2月在北京大学第一医院儿科33例确诊为直立不耐受患儿的家长进行问卷调查,并对其中8位家长进行深度访谈。结果54．5％的家长对疾病有一些了解,45．5％的家长对疾病一无所知;居住城市或城镇的家长中对疾病有所了解的人数所占比例高于农村地区（P〈0．05）;家长对疾病了解程度与其文化程度呈正相关（r=0．438,P〈0．05）。半数以上的家长认为疾病对患儿的心理行为、智力和生长发育造成不良影响,特别是血管迷走性晕厥患儿的家长认为疾病给患儿带来严重影响;大多数家长希望了解疾病相关知识（n=29）,最希望获得的服务方式是门诊咨询（札=29）。结论目前我国直立不耐受患儿及其家长的健康需求未得到满足,应加强对疾病相关知识的普及和宣传,并为患儿及其家长进行健康教育和情感支持。     

Contingent negative variation in children with orthostatic dysregulation

BACKGROUND: Children with orthostatic dysregulation (OD) appear to have hypodynamia, as well as the symptoms described in the OD criteira. Hypodynamia, which is greatly influenced by motivation, volition and concentration, is unexceptionally recognized in their everyday life. It has been suggested that the symptoms and hypodynamia aggravate considerably the quality of life (QOL) of children with OD. The purpose of this study was to distinguish the characteristics of contingent negative variation (CNV) and post imperative negative variation, which may reflect the level of attention and motivation in children with OD. METHODS: Twelve patients with OD aged 10-15 years and 23 age-matched healthy children were included. The CNV was recorded from Fz, Cz and Pz linked to earlobes during 30 trials consisting of a warning stimulus and an imperative stimulus with an interstimulus interval (ISI) of 2 s and an intertrial interval (ITI) of 10 s. The imperative stimulus of each trial required a button to be pressed. RESULTS: The untreated children with OD did not have a significantly smaller CNV amplitude than healthy children. Children with OD treated with midodrine and autonomic training had a significantly larger CNV amplitude than the untreated children, in the area of early, late and total CNV at the three sites. CONCLUSION: The present study confirms that children with OD have diminished motivation and deterioration of concentration, which cause hypodynamia in everyday life. Treatment for OD improves the symptoms, diminished motivation and deterioration of concentration, consequently restoring dynamia. Treatment for OD should be recommended to ameliorate QOL of children with OD.     

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目的探讨儿童体位性心动过速综合征(POTS)的临床特点。方法2008年5月至2009年10月于北京大学第一医院儿科门诊就诊,经直立试验或直立倾斜试验确诊POTS的患儿109例(POTS组),平均年龄(11.79±2.55)岁;20名健康儿童为对照组,平均年龄(11.55±3.65)岁。对每例POTS患儿详细询问病史并进行体格检查,对比分析两组儿童在生活习惯、家族史及体质特征方面特点,总结POTS组患儿发病的临床特征。结果与对照组相比,POTS组患儿在性别比例、年龄、身高、体重、平卧心率、平均动脉压方面差异无统计学意义。POTS患儿主要症状以晕厥多见(52.3%),42.2%症状发作频繁(就诊时>10次),主要症状发生季节以夏秋季多见(42.1%),发作持续时间多在1min以内(29%)。83.5%患儿发作前有诱因,发作诱因以持久站立为多见(50.5%),发作前多伴有先兆症状(78.0%),其中以头晕、黑矇、大汗、面色苍白最为常见。18例(16.5%)患儿有伴随症状,32例(29.4%)发作后仍有不适,以乏力最常见(24例)。90例(82.6%)患儿无既往疾病史,30例(27.6%)有直立不耐受家族史,46例(...     

Japanese clinical guidelines for juvenile orthostatic dysregulation version 1

This clinical practice guideline provides recommendations for the assessment, diagnosis and treatment of school-aged children and juveniles with orthostatic dysregulation (OD), usually named orthostatic intolerance in USA and Europe. This guideline is intended for use by primary care clinicians working in primary care settings. The guideline contains the following recommendations for diagnosis of OD: (i) initial evaluation composed of including and excluding criteria, the assessment of no evidence of other disease including cardiac disease and so on; (ii) a new orthostatic test to determine four different subsets: instantaneous orthostatic hypotension, postural tachycardia syndrome, neurally mediated syncope and delayed orthostatic hypotension; (iii) evaluation of severity; and (iv) judgment of psychosocial background with the use of rating scales. The guideline also contains the following recommendations for treatment of OD on the basis of the result of an orthostatic test in addition to psychosocial assessment: (i) guidance and education for parents and children; (ii) non-pharmacological treatments; (iii) contact with school personnel; (iv) use of adrenoceptor stimulants and other medications; (v) strategies of psychosocial intervention; and (vi) psychotherapy. This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with OD. Rather, it is designed to assist primary care clinicians by providing a framework for decision making of diagnosis and treatments.     

Physiologic neurocirculatory patterns in the head-up tilt test in children with orthostatic intolerance

Background: Orthostatic intolerance (OI) is a common clinical manifestation in clinical pediatrics. The head‐up tilt (HUT) table test is considered the standard of orthostatic assessment, but the physiologic neurocirculatory profile during HUT has not been fully realized in children with OI. The present study, therefore, was designed to investigate the physiologic patterns that occur during HUT in children with OI. Methods: Ninety children (56 girls; mean age, 11.6 ± 2.3 years) with OI underwent HUT under quiet circumstances. Blood pressure and heart rate were monitored simultaneously. Results: Forty‐nine children with OI (54.4%) had vasovagal response with HUT testing; 33 (36.7%), vasodepressor response; six (6.7%), cardioinhibitory response; and 10 (11.1%), mixed response. Twenty‐eight children (31.1%) had postural orthostatic tachycardia; one (1.1%), orthostatic hypotension (OH); and 12 (13.3%), normal physiologic response. Patterns of cerebral syncope response and chronotropic incompetence were not observed. Conclusions: Classical vasovagal response was the major physiologic pattern seen in children with OI during HUT testing, and postural orthostatic tachycardia response ranked second.     

儿童体位性心动过速综合征诊治策略

体位性心动过速综合征(POTS)是一组以慢性直立不耐受及直立后心率过度增快为主要特征的临床综合征,在儿童及青少年时期较为常见,可显著影响儿童的生活质量及学习。POTS症状涉及多个系统,并可伴有多种共患疾病,临床表现复杂,在诊断中需详细询问病史,正确解读直立试验结果,谨慎鉴别诊断并全面评估共患病。POTS主要有相对低血容量、高肾上腺素能及血管功能障碍三种核心机制。在治疗POTS患儿时,应以非药物治疗为基础,针对患儿的临床特点及生物标志物水平评估主要发病机制,注意共患疾病的管理,从而进行个体化的综合治疗。