儿童血管迷走性晕厥在直立倾斜试验中的特点

目的探讨儿童血管迷走性晕厥(vasovagal syncope,VVS)在直立倾斜试验(head-up tilt test,HUTT)中的特点,寻找VVS在HUTT中发生晕厥的预警指标,以便早期识别VVS阳性反应,降低检查风险。方法回顾性分析2018年1月~2019年8月因不明原因晕厥于某院行HUTT检查的患儿在HUTT中临床表现、心率及心电图等特点。结果①基础直立倾斜试验(based head-up tilt test,BHUT)中,临床表现胸闷在阴性组有1例(2%),VVS组9例(22%),差异具有统计学意义(P<0.05)。②硝酸甘油激发直立倾斜试验(sublingual nitroglycerin head-up tilt test,SNHUT)中,临床表现头晕、胸闷、面色苍白、恶心、视物模糊、乏力及发热在两组有统计学差异(P<0.05)。③HUTT中心电图,阴性组和VVS组有统计学差异(P<0.05)。④VVS阳性反应平均时间是在SNHUT开始后的5~10 min,且在SNHUT开始后的前3 min心率较试验前基础心率平均上升30.4%。结论通过观察HUTT中临床表现、心率变化及心电图改变,可一定程度上预测VVS的发生。

Characteristics of vasovagal syncope in children during head up tilt table test

Objective To explore the characteristics of vasovagal syncope(VVS)in children in head up tilt test(HUTT),and to find the early warning indicators of VVS syncope in HUTT,so as to identify the positive reaction of VVS and reduce the risk of examination.Methods The clinical manifestations,heart rate and ECG of the children with syncope due to unknown causes in Hutt from January 2018 to August 2019 were analyzed retrospectively.Results①In the basic head up tilt test(BHUT),the clinical manifestations of chest distress were 1(2%)in the negative group and 9(22%)in the VVS group(P<0.05).②The clinical manifestations of dizziness,chest tightness,pallor,nausea,blurred vision,asthenia and fever were statistically different between the two groups(P<0.05).③There was significant difference between the negative group and VVS group(P<0.05).④The average time of VVS positive reaction was 5~10 minutes after the start of SNHUT,and the heart rate in the first 3 minutes after the start of SNHUT was 30.4%higher than that of the basic heart rate before the test.Conclusion The occurrence of VVS can be predicted to some extent by observing the clinical manifestations,heart rate changes and ECG changes in HUTT.