24小时血压监测评价儿童神经介导性晕厥治疗效果

目的：探讨24 h血压监测（ABPM）评价儿童神经介导性晕厥（NMS）治疗效果。方法：选择2010年 2月至2012年8月以不明原因晕厥或先兆晕厥为主诉,经直立倾斜试验（HUTT）诊断明确的NMS患儿28例,其中男12例,女16例,年龄6～13岁。经健康教育结合口服补液盐（ORS）治疗后复查临床症状、HUTT及ABPM。结果：（1）28例NMS患儿中,血管抑制型22例,混合型5例,心脏抑制型1例。（2）治疗效果随访：临床症状好转率96%（27/28）,HUTT好转率64%（18/28）。（3）ABPM随访：全天平均收缩压、全天平均舒张压、日间平均收缩压、日间平均舒张压、夜间平均收缩压、夜间平均舒张压、收缩压昼夜差值、舒张压昼夜差值在治疗前后差异均无统计学意义（P>0.05）。（4）ABPM参数昼夜变化模式：“勺型血压”从治疗前的29%（8/28）提高到治疗后的50%（14/28）;“非勺型血压”从治疗前的71%（20/28）下降到治疗后的50%（14/28）。结论：ABPM作为一种有效、客观、无创性监测方法,对评价儿童NMS治疗效果具有一定的临床意义。

Investigation of 24-hour blood pressure monitoring for evaluating treatment outcome of nerve-mediated syncope in children

Objective To investigate the clinical significance of 24-hour blood pressure monitoring(ABPM) for evaluating the treatment outcome of nerve-mediated syncope(NMS) in children.Methods Twenty-eight children with NMS confirmed by a head-up tilt table test(HUTT)(12 males and 16 females,aged 6-13 years) and with a chief complaint of unexplained syncope or pre-syncope between February 2010 and August 2012,were included in the study.These children received health education combined with therapy using oral rehydration salts solution and were then reexamined for clinical symptoms as well as HUTT and ABPM results.Results Of 28 NMS cases,22 were vasodepressive type,5 were mixed type,and 1 was cardioinhibitory type.The follow-up showed that 27(96%) of all cases had improved clinical symptoms,and 18(64%) had improved HUTT results.The ABPM follow-up revealed no significant changes in 24-hour mean systolic pressure,24-hour mean diastolic pressure,daytime mean systolic pressure,daytime mean diastolic pressure,nighttime mean systolic pressure,nighttime mean diastolic pressure,day-night difference of systolic pressure,and day-night difference of diastolic pressure after treatment(P>0.05).The percentage of children with a dipper blood pressure pattern increased from 29%(8/28) before treatment to 50%(14/28) after treatment;the percentage of children with a non-dipper blood pressure pattern decreased from 71%(20/28) before treatment to 50%(14/28) after treatment.Conclusions As an effective,objective and non-invasive monitoring means,ABPM is of some clinical significance for evaluating the treatment outcome of NMS in children.