儿童血管迷走性晕厥临床分析

目的：研究儿童血管迷走性晕厥（vasovagal syncope，VVS）临床情况。方法：2000年1月至2009年9月在中南大学湘雅二医院儿科门诊就诊或住院的不明原因晕厥或先兆晕厥患儿841例，依据检查年限分为两组，2000年1月至2004年12月为A组，共129例；2005年1月至2009年9月为B组，共712例；并按照年龄分为4岁~、7岁~及11~18岁3个年龄组。经直立倾斜试验（head-up tilt table test，HUTT）检查诊断为VVS。结果：HUTT总阳性率为45.3% (381/841)，B组阳性率较A组明显增加（47.5% vs 33.3%，P7岁~组>4岁~组（49.2% vs 44.1% vs 37.1%），组间比较差异有统计学意义；7岁~组和11~18岁组中B组HUTT阳性率明显高于A组(46.2% vs 27.8%； 54.0% vs 32.6%，P＜0.05)。HUTT阳性率反应类型比较，依次为血管抑制型>混合型>心脏抑制型（70.9% vs 25.5% vs 3.6%），组间比较差异有统计学意义，其中血管抑制型表现为B组HUTT阳性率高于A组(72.5% vs 58.1%，P＜0.05)。结论：近5年VVS的发生率、反应类型发生显著变化，提示VVS的发生受社会因素、精神因素、生活方式等多种因素的影响。［中国当代儿科杂志，2010，12（9）：723-725］

Clinical analysis of vasovagal syncope in children

Objective To study the changes in clinical features of vasovagal syncope (VVS) in children.Methods From January 2000 to September 2009,841 children with unexplained syncope or prodromata were enrolled.They were assigned to two groups according to the period of visiting hospital:group A (from January 2000 to December 2004,n=129) and group B (from January 2005 to September 2009,n=712).They were assigned to three age groups:4-6 years old,7-10 years old and 11-18 years old.A head-up tilt table test (HUTT) was performed on all the subjects.Results The total positive rate of HUTT was 45.3% (381 /841).Compared with that in group A,the positive rate of HUTT in group B increased significantly (47.5% vs 33.3% ;P < 0.05).The positive rate of HUTT in female children was significantly higher than that in male children (49.3% vs 37.9% ;P < 0.05).The positive rate of HUTT increased with age and it was the highest in children at age of 11-18 years (49.2%),followed by in children at age of 7-10 years (44.1%) and 4-6 years (37.1%) (P <0.05).The children at age of 7-10 years and 11-18 years from group B showed significantly higher positive rate of HUTT than those from group A (46.2% vs 27.8% ;54.0% vs 32.6%,P < 0.05).Vasodepressor type was the most common response type (70.9%) shown by HUTT compared with mixed type (25.5%) and cardioinhibitory type (3.6%) (P < 0.05).The proportion of children with vasodepressor response type in group B was significantly higher than that in group A (72.5% vs 58.1% ;P < 0.05).Conclusions There were obvious changes in the prevalence of VVS and response types before and after five years,suggesting that the development of VVS may be attributed to many factors,such as social factors,mental factor and life style.