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目的探讨鉴别血管迷走性晕厥(VVS)及体位性心动过速综合征(POTS)的临床依据。方法 2009年4月至2011年4月于北京大学第一医院儿科门诊就诊并确诊为VVS的儿童40例,年龄6～18岁,平均(11.8±2.9)岁;POTS儿童165例,年龄5～19岁,平均(11.4±2.7)岁。评价与检查手段包括临床表现、家族史、生活习惯、直立试验以及直立倾斜试验。结果 VVS和POTS在儿童时期的共同特征包括学龄期及青春期多发、女孩稍多于男孩、发作季节以夏秋季多见、多数患儿有诱因和发作先兆、发作后仍有不适、平卧后症状可缓解。在VVS儿童中以晕厥为主要表现者明显多于POTS(P<0.001),在POTS儿童中,以头晕为表现的患儿明显多于VVS(P<0.001)。VVS患儿中父方有直立不耐受家族史者明显多于POTS患儿(P<0.05)。结论直立倾斜试验是鉴别VVS与POTS的重要客观检查手段。晕厥及头晕的发生频率对于临床鉴别诊断VVS与POTS具有参考价值。

Clinical characteristics of vasovagal syncope and postural orthostatic tachycardia syndrome in children.

Objective To investigate the clinical evidence for differential diagnosis between vasovagal syncope(VVS) and postural orthostatic tachycardia syndrome(POTS) in children.Methods Forty children [aged 6～18 yrs,median(11.8 ± 2.9) yrs] who were diagnosed with VVS and 165 children [aged 5～19 yrs,median(11.4±2.7) yrs] who were diagnosed with POTS in the clinics of Peking University First Hospital from March 2009 to April 2011 were recruited in the study.History-taking,including clinical manifestation,family history,life style,physical examination,standing test and head-up tilt test,etc,was done for each patient.Clinical characteristics of VVS and POTS in children were summarized by comparing the two groups.Results There were some similar characteristics between VVS and POTS.Both VVS and POTS were usually at school-age or adolescent period.Their symptoms mostly occurred in summer and autumn.Most patients had trigger of symptoms and presyncope symptoms.Moreover,most patients had complaint after the episodes.The symptoms would be relieved when supine in most patients.The frequence of syncope was higher in the children with VVS than those with POTS(P < 0.001),while the frequence of dizziness was higher in the children with POTS than those with VVS(P < 0.001).The percentage of patients whose fathers have a family history of orthostatic intolerance in children with VVS was higher than that of children with POTS(P < 0.05).Conclusion Head-up tilt test is an important and objective examination in differential diagnosis between VVS and POTS in children.The frequence of syncope and dizziness could be used as a reference indication to help differentiate diagnosis between VVS and POTS.