晕厥的病因分析及鉴别诊断

目的了解儿童晕厥病因组成特点,探讨以发病诱因及症状区分心源性与神经介导性晕厥的可行性。方法对111例住院患儿病例进行综合评估,以规范的诊断步骤对确诊晕厥的患儿进行病因分类。总结导致晕厥的诱因、先兆症状及发作症状,对心源性及神经介导性晕厥患儿资料中行统计学处理,试图发现两种晕厥的特征性表现。结果非心源性晕厥者占60.4%,直立性低血压占18.9%,血管迷走性晕厥及心源性晕厥分别占18.0%和9.0%。非心源性晕厥中以神经介导性晕厥为主。心源性仅占全部晕厥患者的极小部分。晕厥发作前持久站立及恶心是神经介导性晕厥的特征性表现。心源性晕厥往往与运动相关。结论非心源性晕厥者占晕厥患儿的大多数,其中以神经介导性晕厥为主。运动相关的晕厥为心源性晕厥的特征。发作前直立体位、伴恶心症状的多为神经介导性晕厥。

Etiological Analysis and Differential Diagnosis of Syncope in Children

Objective To study the feature of the etiology of pediatric syncope by cases study,and to discuss the feasibility on identification between the cardiac and neurally-mediated syncope with its inducements and symptoms.Methods One hundred and eleven patients were etiologically classified by standard diagnostic procedure to summarize the inducements,presymptoms and symptoms.The data about cardiac and neurally-mediated syncope were statistically treated to find their characteristic manifestation.Results Among these,60.4% was non-cardiovascular syncope,18.9% was postural hypotension,18.0% was vasovagal syncope and 9% was cardiac syncope.Most of them were non-cardiac syncope and neurally-mediated syncope was on the top,while cardiac syncope was rare in children.Prolonged standing and nausea was the feature of the neurally-mediated syncope,and the cardiac syncope is associated with physical exercise.Conclusions Most pediatric inpatients were non-cardiovascular syncope in which neurally-mediated syncope is first on the list.The movement-related syncope is the feature of the cardiac syncope.The prolonged standing and nausea are due to neurally-mediated syncope.