儿童直立倾斜试验阳性反应时心律失常分析

Analysis of arrhythmic events in children with positive responses during head-up tilt table test

目的探讨儿童直立倾斜试验（HUTT）阳性反应时心律失常发生情况及临床意义。方法对2000年9月-2005年7月在晕厥专科门诊就诊或住院的不明原因晕厥或接近晕厥患儿进行HUTT，阳性反应77例（男28例，女49例；年龄7～18岁），分析HUTT时心律失常发生情况，采用SPSS11．0软件进行统计。结果出现心律失常76例（98．7％），发生窦速71例（92，2％），其中60例在心率达最快后5min[平均（1.5±1，7）min]内发生阳性反应。发生缓慢性心律失常26例（33，8％），与舌下含服硝酸甘油倾斜试验（SNHUT）相比，基础直立倾斜试验（BHUT）中发生率高（P〈0．05），而不同性别、年龄组（〈12岁、≥12岁）间差异无显著性（P〉0．05），以窦缓多见（20／26例），其次为交界性逸搏心律、窦性停搏、交界性逸搏。5例窦性停搏患儿停搏时间平均为18．2s（1．5～60s）。结论HUTT时心率突然明显增快时应警惕发生阳性反应；缓慢性心律失常在BHUT中发生率较高，常见类型有窦缓、交界性逸搏心律、窦性停搏、交界性逸搏等；应积极预防和处理严重阳性反应。

Objective To discuss the incidence and clinical significance of arrhythmic events in children with positive responses in head-up tilt table test（HUTT）. Methods 77 children （28 male, 49 female, age 7-18 yrs） who came from syncope outpatient department or in-patient department of our hospital with positive responses during HUTT were enrolled in this study. SPSS 11.0 software was used for the statistical analysis of these data. Results Arrhythmic events occurred in 76 patients （98.7%）. Sinoatrial tachycardia occurred in 71 cases （92.2%） of them, 60 patients had positive responses within 5 min （1.5 ± 1.7min） after their heart rates reached maximum. Bradyarrhythmias happened in 26 patients （33.8%） and more common in baseline head-up tilt table test（BHUT） with no significant difference between different gender groups or different age groups. Sinoatrial bradycardia was more common （20/26）. Other types of bradycardia included junctional escape rhythm, asystole and junctional escape. The averaged time of asystole in 5 sinus arrest cases was 18.2s（1.5-60 s） . Conclusions （1） Positive response should be suspected when patient＇ s heart rate increases abruptly during HUTT. （2） Bradyarrhythmia is more often seen in BHUT, sinoatrial bradycardia, junctional escape rhythm, asystole and junctional escape are common types. （3）Serious positive response should be prevented and managed in time.