儿童心脏神经功能性疾病112例分析

Clinical analysis for 112 cases of cardiac neuro-functional disease in children

目的探讨儿童心脏神经功能性疾病的特点及与器质性心脏病的鉴别。方法对儿童以憋气、胸闷等症状就诊的心脏神经功能性疾病112例的临床资料进行回顾性分析。结果112例均无心脏阳性体征,常规做X线胸透和(或)超声心动图、心电图、心向量图、心肌酶等检查,结果均正常者47例,其中心脏神经症35例、直立调节障碍12例。因心电图异常疑似心肌炎者65例,其中有STT改变的28例经心得安试验证实为β肾上腺素能受体功能亢进症;37例心电图示电轴左偏或疑似左前束支传导阻滞,后者经心向量图检查排除了左前束支传导阻滞,明确为电轴左偏。65例均排除了心肌炎。对住院的35例进行病因分析,显示其与社会、家庭、自身等因素有关。结论心脏神经功能性疾病应与心肌炎鉴别,治疗上应注意消除病因,心理治疗或辅以β受体阻滞剂可改善症状。

Objective To investigate clinical characteristics of cardiac neuro-functional diseases in children and to differentiate them from organic heart diseases. Methods A total of 112 cases of cardiac neuro-functional diseases in children, with symptoms of shortness of breath, chest distress, and so on, were retrospectively analyzed. Results No positive cardiac signs were found in all 112 cases on physical examinations and 47 cases were all normal with routine chest X-ray and/or echocardiography, electrocardiography （ECG）,vectocardiography,measurements of myocardial enzymes activities, etc. Thirty- five of the 47 cases were diagnosed as cardiac neurosis and 12 as disturbance in orthostatic regulation. Suspected myocarditis with abnormal ECG was found in 65 of 112 cases, and 28 of them with ST-T changes were diagnosed as hyperfunction of β-adrenergic receptor by propranolol test, and 37 of them were diagnosed as left axis deviation or suspected for left anterior bundle branch block with ECG, the latter cases were diagnosed as left axis deviation （LAD） with vectocardiography, then organic heart diseases were all ruled out in them. Thirty-five hospitalized cases were analyzed for the association between cardiac neuro-functional diseases and their social, familial and personal characteristics. Conclusions Cardiac neuro-functional diseases in children should be differentiated from myocarditis in diagnosis. Treatment for them includes etiological and psychological aspects or administration with β-adrenergic blockers.