小儿周期性呕吐综合征41例报告

Clinical characteristics of 41 children with cyclic vomiting syndrome

目的分析小儿周期性呕吐综合征(CVS)的临床特点及诊治经验。方法对1994至2007年确诊为 CVS 的41例患儿的临床资料、诊断治疗及随访结果进行分析。结果本组41例,男21例,女20例,平均年龄8岁,平均发病年龄4岁,平均病程4年。呕吐可持续数天,间有完全健康的间歇期。重症发作高峰时呕吐次数>6次/h。全组发作期有精神萎靡、不能交流、顽固恶心、不能进食、发作呈突发突止的刻板形式,此为小儿 CVS 特征表现。1994至2000年随访8例,3例用多虑平和阿普唑仑治疗后2.2年(1.0-4.0年)痊愈;5例未按医嘱预防性治疗者,就诊后7.7年(4~10年)痊愈。2001至2007年随访>1年的14例,9例用丙戊酸钠、多塞平、塞庚啶联合治疗后2.3年(1~4年)痊愈;5例未按医嘱预防性治疗者,就诊后1.9年(1~3年)痊愈。结论小儿 CVS 的诊断应根据发作期特征性表现,有完全健康间歇期,并排除器质性呕吐病因。大多数 CVS 患儿症状随年龄增长而减轻。对发作频率≥1次/月,并影响生长发育的重症患儿,应给予精神安定剂、抗抑郁剂、抗偏头痛剂等长期预防性治疗;对轻症患儿,则采用发作期抗呕吐、输液等对症综合治疗。

Objective To analyze the clinical characteristics of children with cyclic vomiting syndrome(CVS),summarize the experience for twelve years,and improve awareness,diagnosis and treatment level of CVS.Methods The clinical data and results of long-term follow-up of the children with CVS seen from 1994 to 2007 in our department were analyzed.Results Forty-one children were enrolled in the study,21 were male,and 20 female,mean age was 8 years,mean age of onset was 4 years,mean interval from onset to proper diagnosis was 4 years;13/41 and 20/41 patients had family history of migraine and motion sickness,20/41 patients had triggers,such as upper respiratory tract infection,diet,and mental/emotional factor.Vomiting lasted for days,during the periods between the episodes of vomiting the children were completely healthy.The intervals of most patients were 2 to 8 weeks,and in 12/41 patients the episodes started at early morning.The peak number of emesis per hour exceeded six in 23/41 children.The episodes were characterized by a pattern of sudden onset and sudden ending.All patients showed depressed,social withdrawal,intractable nausea and anorexia.Associated symptoms and signs include pallor,excess salivation,hypertension,headache,photophobia,and abdominal pain.Electroencephalogram of 13/33 patients were slighfly abnormal.Electrogastrogram showed dysrhythmia and gastrointestinal motility were abnormal during the period of onset and normal during complete remission.Eleven of the 41 of patients were treated as epilepsy,and 9 patients were diagnosed as esophageal hiatal hernia and 4 superior mesenteric artery compression syndrome and had surgery before the diagnosis was made.Eight patients diagnosed from 1994 to 2000 were followed up for ten years in average,3 patients were treated with doxepin and alprazolanic,and were cured after 2.2(1.0-4.0)years;and five patients who did not use any medicine recovered 7.7(4-10)years later.Fourteen children diagnosed from 2001 to 2007 were followed up for longer than one year,9 patients were treated with valproate,doxepin,cyproheptadine,and recovered 2.3(1-4)years later;5 patients without treatment recovered 1.9(1-3)years later.Conclusions The diagnosis must be based on the special manifestation of CVS,including intervals during which the patients are completely healthy,and the systemic diseases which can cause CV should be excluded.Most patients get better as they grow up.Therapeutic strategies may include combined use of neuroleptics,thymoleptics and anti-migraine when the episodes occur frequently and when there is growth retardation.Supportive care includes intravenous fluids and symptomatic treatment during all episode.