体位性心动过速综合征儿童心率变异性特征

目的:回顾性研究体位性心动过速综合征(POTS)儿童心率变异性(HRV)特征,探讨其在体位性心动过速综合征中的临床意义。方法:选择2012年1月~2013年3月在吉林大学第一医院小儿心血管科门诊就诊或病房住院、确诊为POTS患儿共27例作为POTS组,选择同期在门诊体检健康儿童31例作为健康对照组。所有入选儿童均行动态心电图检查,对心率变异性时域指标进行分析。结果:与对健康照组相比,POTS组儿童心率变异性时域指标SDNN(全程窦性心率间RR间期标准差)、SDNNindex(全程每5minRR间期标准差的均值)、p NN50(全程RR间期>50 ms占全部RR间期的百分比)均升高,差异具有统计学意义(P<0.01),SDANN(全程每5 minRR间期均值标准差)、r MSSD(相邻RR间期差值均方根值)、三角指数(全部RR间期直方图中RR间期总数除以占比例最大的RR间期数)均升高,差异具有统计学意义(P<0.05)。结论:POTS患儿HRV升高,自主神经功能受损,HRV时域指标分析对辅助诊断POTS有一定的临床意义。     

儿童体位性心动过速综合征46例临床分析

目的 探讨儿童体位性心动过速综合征的临床特征.方法 收集我院2007年1月至2010年10月收治的以直立不耐受症状就诊并确诊为POTS的患儿共46例,同时选取24例正常儿童作为健康对照组,对患儿病史进行采集,详细询问患儿主要症状病程、发病时间、诱因、伴发症状,询问患儿既往史、有无晕阙史等.对人组研究的所有儿童进行身高、体重、心率、平卧状态的血压测定,并对患儿进行直立试验以及HUT检查.结果 POTS患儿主要发作诱因包括体位改变、持久站立、精神紧张、运动、疲劳、感染以及月经期;主要症状包括晕厥、头晕、大汗、胸闷、心悸、恶心呕吐、头痛以及视物模糊等.POTS组与对照组各项基本资料比较差异无统计学意义(P＞0.05).POTS组患儿治疗后症状评分、直立心率以及心率差值较治疗前显著改善,差异有统计学意义(P＜0.05).结论 POTS患儿各项基本资料与正常儿童之间差异无统计学意义,常见症状为晕厥、头晕、大汗、胸闷,而β1受体阻滞剂联合生理盐水口服可有效地治疗体位性心动过速综合征.     

盐酸米多君治疗儿童体位性心动过速综合征疗效观察

体位性心动过速综合征（postural orthostatic tachycardia syndrome,POTS）是一组病因不明的临床 综合征,又称特发性直立不耐受综合征、直立性心动 过速综合征,特征性的临床表现是当患者由卧位快 速变换为直立体位或持久站立时出现直立不耐受 （orthostatie intolerance,OI）症状,并且患者在直立试 验或直立倾斜试验（head-up tilt test,HUT）时,于 10min内心率比卧位时增加≥35次/min,或心率最大 值≥120次/min[1]。POTS是成人OI最常见的一种类 型,多无生命危险,但反复发生的OI症状对患儿的身 心健康具有比较严重的影响[2],因此,对POTS患儿进 行治疗是必要的。β受体阻滞剂治疗POTS具有一定 的效果,但部分患儿难以耐受药物副作用[3]。盐酸米 多君（midodrine）临床常用于治疗体位性低血压和神 经源性直立性低血压,以及其他多种原因导致的低 血压。笔者使用盐酸米多君治疗POTS,取得较好临 床疗效,现报道如下。     

儿童体位性心动过速综合征临床分析

目的：探讨儿童体位性心动过速综合征（POTS）的临床特征。方法：以符合POTS诊断标准的40例患儿为研究对象，分析年龄分布、家族遗传特征及血液动力学指标，同时观察其各种临床表现的发生频率及辅助检查结果。结果：诊断为POTS的患儿40例，其中男性15例，女性25例，男女比例为1：1．7，年龄10～16岁，平均为14±1．5岁，10例具有家族遗传性，占25％。最常见临床表现为直立后出现头晕、头痛、胸闷、心悸、面色改变、视物模糊、倦怠、晨起不适，严重时甚至出现眩晕、晕厥等直立不耐受或直立调节障碍症状。在直立试验（先安静平卧10min，然后直立10min）或直立倾斜（HUT）试验过程中，POTS患儿最常见的异常表现为在直立或倾斜后10min内，心率增加1〉35次／min，或患儿心率测最大值≥120次／min，但血压下降〈20／10mmHg为诊断标准。出现异常表现的时间平均为7±2min，15例直立6min出现异常症状，10例在直立后即可出现异常症状，15例作HUT约10min内出现异常症状。结论：POTS常见于学龄期女童，有一定的遗传性，常见的症状为头晕、胸闷、心慌等，HUT为诊断POTS敏感且重要的方法。     

体位性心动过速综合征儿童血浆尾加压素Ⅱ和儿茶酚胺抑素的变化及意义

目的：通过检测体位性心动过速综合征（postural orthostatic tachycardia syndrome, POTS）患儿心血管活性肽含量的变化,探索其发病机制。方法：采用临床对照研究的方法,POTS组为于北京大学第一医院儿科门诊就诊的POTS儿童46例（平均12.1±2.8岁）,对照组为健康儿童20例（平均11.5±3.6岁）,采用酶免疫法测定血浆尾加压素Ⅱ（urotensin Ⅱ, UII）及儿茶酚胺抑素（catestatin,Cs）浓度,分析POTS组患儿血管活性肽含量的变化及与直立后心率变化的相关性。结果：与对照组相比,POTS组患儿血浆UII水平降低［0.41 (0.27, 0.85) μg/L vs. 0.46 (0.35, 1.41) μg/L,P<0.05］,血浆UII水平与直立10 min后心率的变化次数呈负相关（相关系数-0.363, P<0.05）,血浆Cs浓度两组差异无统计学意义［0.48 (0.20, 1.91) μg/L vs. 0.52 (0.18, 1.60) μg/L,P>0.05］。结论：POTS患儿血浆UII水平降低,提示血管张力调节异常可能是POTS的发病机制之一。     

血清铁在鉴别儿童血管迷走性晕厥和体位性心动过速综合征中的意义

目的：分析血清铁在儿童血管迷走性晕厥（vasovagal syncope,VVS）和体位性心动过速综合征（postural orthostatic tachycardia syndrome,POTS）鉴别诊断中的意义。方法：2009年8月至2012年9月间就诊于北京大学第一医院儿科晕厥专业门诊或住院的年龄4~17岁的患儿共57例,其中确诊为POTS的患儿40例,VVS患儿17例。采用血清铁及其受试者操作特征（receiver operating characteristic,ROC）曲线分析不同血清铁值对鉴别儿童VVS和POTS的预测价值。结果：POTS患儿血清铁值中位数为17.4 μmol/L（四分位数间距13.5~21.8 μmol/L）,VVS患儿血清铁值中位数为8.9 μmol/L（四分位数间距7.5~17.6 μmol/L）,两组间比较差异有统计学意义（P<0.01）。以血清铁11.8 μmol/L作为界值对VVS和POTS患儿进行鉴别的灵敏度为92.5%,特异度为64.7%。结论：血清铁可能作为临床上鉴别VVS和POTS的初步方法。     

体位性心动过速综合征

1993年由Schondoff和Low首先提出儿童体位性心动过速综合征（postural orthostatic tachycardia syndrome，POTS）的概念，2005年北京大学第一医院儿科在国内首先报道我国儿童POTS，提出其临床特征。POTS是慢性直立不耐受的表现之一，目前其患病率没有确切的统计。     

血清铁在鉴别儿童血管迷走性晕厥和体位性心动过速综合征中的意义

目的:分析血清铁在儿童血管迷走性晕厥(vasovagal syncope,VVS)和体位性心动过速综合征(postural orthostatic tachycardia syndrome,POTS)鉴别诊断中的意义。方法:2009年8月至2012年9月间就诊于北京大学第一医院儿科晕厥专业门诊或住院的年龄4~17岁的患儿共57例,其中确诊为POTS的患儿40例,VVS患儿17例。采用血清铁及其受试者操作特征(receiver operating characteristic,ROC)曲线分析不同血清铁值对鉴别儿童VVS和POTS的预测价值。结果:POTS患儿血清铁值中位数为17.4μmol/L(四分位数间距13.5~21.8μmol/L),VVS患儿血清铁值中位数为8.9μmol/L(四分位数间距7.5~17.6μmol/L),两组间比较差异有统计学意义(P<0.01)。以血清铁11.8μmol/L作为界值对VVS和POTS患儿进行鉴别的灵敏度为92.5%,特异度为64.7%。结论:血清铁可能作为临床上鉴别VVS和POTS的初步方法。     

儿童血管迷走性晕厥和体位性心动过速综合征共患过敏性疾病的临床特征分析

目的 探讨儿童血管迷走性晕厥(vasovagal syncope,VVS)及体位性心动过速综合征(postural tachycardia syndrome,POTS)共患过敏性疾病的临床特点。方法 回顾性分析67例VVS及POTS儿童的临床资料,比较共患过敏性疾病与非共患过敏性疾病患儿的一般情况、症状评估、过敏指标以及直立试验或直立倾斜试验中的血流动力学特点,组间比较采用独立样本t检验或秩和检验,组成比比较采用χ²检验。采用双变量相关分析检验嗜酸性粒细胞百分比及计数与症状评分/晕厥发生频率的相关性。P<0.05为差异有统计学意义。结果 67例患儿中(VVS 43例,POTS 24例)共有21例(31%)共患过敏性疾病,伴随的过敏性疾病包括过敏性鼻炎、支气管哮喘、变应性皮炎及食物过敏,其中以过敏性鼻炎最为常见。过敏组与非过敏组患儿在就诊年龄、性别比例、基础血压方面差异无统计学意义。与非过敏组相比,过敏组的起病年龄(月)较大[11±2 vs. 9±3],病程(月)偏短[8.0(0.1,24.0) vs. 12.0(0.1, 144.0)]。在VVS患儿中过敏组晕厥发生频率(次/月)较非过敏组高[2.50(0.08,30.00) vs. 0.25(0.03,5.00)]。过敏组嗜酸性粒细胞百分比(%)[3.50(0.70,5.90) vs. 1.65(0.30,6.20)]及计数(×10⁹)[0.18(0.05,0.71) vs.0.10(0.02,0.38)]较非过敏组更高,P均<0.05。VVS患儿中,过敏组与非过敏组相比直立倾斜试验阳性反应时间差异无统计学意义。在POTS患儿中,过敏组与非过敏组患儿在直立不耐受症状评分及直立试验中心率增加最大值方面差异无统计学意义。结论 过敏性疾病是VVS及POTS儿童常见的共患病,其中过敏性鼻炎最为常见;具有过敏性疾病的患儿出现直立不耐受表现的起病年龄较大,更可能因短期内发作较为频繁而就诊;VVS合并过敏性疾病时晕厥发生频率更高。     

成人体位性心动过速综合征82例临床特征

目的 探讨成人体位性心动过速综合征(postural orthostatic tachycardia syndrome, POTS)的临床特征。方法 分析经直立倾斜试验(head-up tilt test,HUTT)诊断为 POTS 的患者82例,其平均年龄(38.7±12.24)岁;以直立倾斜试验阴性排除POTS的31名受试者为对照组,平均年龄(39.22±10.98)岁。对POTS患者详细询问病史并进行体格检查,分析POTS患者发病的临床特征。结果 与对照组相比,POTS组患者在性别比例、年龄、平卧位心率和血压方面差异无统计学意义。POTS患者以晕厥多见(63例,76.8%),症状发作频繁34.14%(发作 >10次)。晕厥发作和非晕厥患者(19例,23.2%)间性别、年龄比较差异无统计学意义。大多数POTS患者发作前有诱因,诱因多为体位变化、情绪紧张、劳累、运动、天气闷热等。常见的临床表现为晕厥、头晕、心悸、胸闷、黑矇、大汗、面色苍白、乏力。在直立倾斜试验中, POTS患者心率逐渐增加,平均最大增加值为(45.05±11.06)次/min。结论 POTS在各年龄阶段均可发生,晕厥发生率较高。诱因以情绪紧张、劳累、运动、天气闷热多见。     

Baseline left ventricular ejection fraction associated with symptom improvements in both children and adolescents with postural tachycardia syndrome under metoprolol therapy

Background:Postural tachycardia syndrome (POTS) is a common childhood disease that seriously affects the patient''s physical and mental health. This study aimed to investigate whether pre-treatment baseline left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) values were associated with symptom improvement after metoprolol therapy for children and adolescents with POTS.Methods:This retrospective study evaluated 51 children and adolescents with POTS who received metoprolol therapy at the Peking University First Hospital between November 2010 and July 2019. All patients had completed a standing test or basic head-up tilt test and cardiac echocardiography before treatment. Treatment response was evaluated 3 months after starting metoprolol therapy. The pre-treatment baseline LVEF and LVFS values were evaluated for correlations with decreases in the symptom score after treatment (ΔSS). Multivariable analysis was performed using factors with a P value of <0.100 in the univariate analyses and the demographic characteristics.Results:A comparison of responders and non-responders revealed no significant differences in demographic, hemodynamic characteristics, and urine specific gravity (all P > 0.050). However, responders had significantly higher baseline LVEF (71.09% ± 4.44% vs. 67.17% ± 4.88%, t = −2.789, P = 0.008) and LVFS values (40.00 [38.00, 42.00]% vs. 36.79% ± 4.11%, Z = −2.542, P = 0.010) than the non-responders. The baseline LVEF and LVFS were positively correlated with ΔSS (r = 0.378, P = 0.006; r = 0.363, P = 0.009), respectively. Logistic regression analysis revealed that LVEF was independently associated with the response to metoprolol therapy in children and adolescents with POTS (odds ratio: 1.201, 95% confidence interval: 1.039–1.387, P = 0.013).Conclusions:Pre-treatment baseline LVEF was associated with symptom improvement after metoprolol treatment for children and adolescents with POTS.     

Clinical features and management of postural tachycardia syndrome in children: a single-center experience

Background The incidence of postural tachycardia syndrome （POTS） has been increasing in children and adolescents,while clinical characteristics of POTS in the pediatric population are not fully understood.Methods An observational study was performed in 150 pediatric patients aged between 5 and 18 years who underwent head-up tilt test （HUTT） with the diagnosis of POTS at Peking University First Hospital from March 2008 to August 2013.Demographic data,clinical presentation,autonomic parameters,laboratory findings,and treatments were recorded.Results POTS in children commonly occurred in the age of 7-14 years.Dizziness （84.00％） was the most common symptom,followed by weakness （72.00％） and orthostatic syncope （62.67％）.Positive family history of orthostatic intolerance （Ol） was found in 24.64％ of children with POTS.And 33.09％ of them had preceding infection history as precipitating events.Ten percent of them suffered from orthostatic hypertension.Hyperadrenergic status was documented in 51.28％ of 39 patients who were tested for the standing norepinephrine levels.More than half of POTS patients,with 24-hour urinary sodium level ＜124 mmol/24 hours,were suitable for treatment of salt supplementation.At least 25.74％ of POTS patients were of positive acetylcholine receptor （AChR） antibody.Low iron storage in children with POTS was relatively rare.Most patients responded well to treatments,43.51％ of patients recovered,while 7.63％ of them had relapse after symptoms disappeared.Conclusions POTS is a relatively common condition with complex pathophysiology and heterogeneous clinical manifestation.A comprehensive therapeutic regimen is recommended for the treatment.     

A diagnosis-based health economic analysis of postural orthostatic tachycardia syndrome in Chinese children

Background  Postural orthostatic tachycardia syndrome (POTS) is a common clinical problem in children and adolescents. The previous diagnostic approach to POTS of children and adolescents is based on a series of tests to exclude all other causes, which is time and medical resource consuming. Recently, a new diagnostic approach has been developed. The present study was designed to statistically analyze the results of clinical investigation items and the cost for the diagnosis of POTS in children patients, and evaluate cost changes in the diagnosis of POTS.

Methods  A total of 315 children patients were divided into two groups according to diagnosis period, including group I diagnosed in 2002–2006 (100 cases) and group II in 2007–2010 (215 cases) and the diagnostic item-based distribution of the cost was analyzed. The diagnostic costs were compared between two groups using SPSS17.0.

Results  The per-capita cost of diagnosis in group I was (621.95±21.10) Yuan, costs of diagnostic tests (head-up tilt test, standing test, etc) accounted for 8.68% and the exclusive tests for 91.32%. The per-capita cost of diagnosis in group II was (542.69±23.14) Yuan, diagnostic tests accounted for 10.50% and exclusive tests for 89.50%. Comparison of the total cost of diagnostic tests between the two groups showed significant differences (P <0.05).

Conclusion  The cost of POTS diagnosis has been declined in recent years, but the cost of exclusive diagnosis is still its major part.

     

Changes of atrial natriuretic peptide and antidiuretic hormone in children with postural tachycardia syndrome and orthostatic hypertension: a case control study

Background The abnormal blood volume regulation is one of the most important pathogenesis in postural tachycardia syndrome in children.This study was designed to investigate the plasma atrial natriuretic peptide and antidiuretic hormone levels in postural tachycardia syndrome children,and their associations with the changes in heart rate and blood pressure in head-up test.Methods Twenty-one postural tachycardia syndrome patients （（12±2） years） and 26 healthy children （（12±1） years） were included.According to blood pressure changes in head-up test,the postural tachycardia syndrome patients were divided into two subgroups：postural tachycardia syndrome with orthostatic hypertension and postural tachycardia syndrome without orthostatic hypertension.The plasma atrial natriuretic peptide and antidiuretic hormone levels were measured using enzyme-linked immunosorbent assay.Results The plasma atrial natriuretic peptide level in postural tachycardia syndrome patients was higher than the control （P=0.004）,whereas the difference in plasma antidiuretic hormone level between postural tachycardia syndrome and controls was not significant （P=0.222）.The plasma antidiuretic hormone level of patients suffering from postural tachycardia syndrome with orthostatic hypertension was much higher than that of children having postural tachycardia syndrome without orthostatic hypertension （P ＜0.05）.In postural tachycardia syndrome patients,the updght max heart rate was positively correlated with the plasma atrial natriuretic peptide level （r=0.490,P＜0.05） and the upright systolic blood pressure was positively correlated with the plasma antidiuretic hormone levels （r=0.472,P ＜0.05）.Conclusions There was a disturbance of plasma atrial natriuretic peptide and antidiuretic hormone in postural tachycardia syndrome children.     

急性呼吸窘迫综合征患者不同体位通气的护理探讨

目的根据ARDS患者的病变特点,探讨不同体位通气的护理效果。方法利用重力引流原理,针对患者自身情况,每2-12小时转变体位（俯卧位、侧卧位或倾斜卧位）,辅以叩背,及时吸引出痰液,改善通气并进行血气分析,监测血氧饱和度。结果本组14例患者的血氧饱和度由变换体位前80-90%上升至变换体位后90～98%;气道阻力由30cmH2O降至20cmH2O,呼吸明显改善,住ICU病房7～20天后转至普通病房。结论俯卧位通气实施过程复杂且有较多禁忌症,间歇变换其他体位,也能使萎陷的肺泡复张,改善肺的气体交换,使肺通气/血流的比值更加合理,促进分泌物流通。从而尽早脱离呼吸机,减少监护病房住院时间,提高救治成功率。