β-受体阻滞剂联合口服生理盐水治疗儿童体位性心动过速综合征疗效分析

Efficacy of βreceptorl blocker plus oral saline in the treatment of postural orthostatic tachycardia syndrome in children

目的探讨β-受体阻滞剂联合生理盐水对儿童体位性心动过速综合征(postural orthostatic tachy-cardia syndrome,POTS)的治疗作用。方法对经过直立倾斜试验(head-up tilt test,HUT)确诊的30例POTS患儿分为对照组(10例)及治疗组(20例),对照组给予健康教育及生理盐水250ml,bid治疗;治疗组给予健康教育、口服生理盐水以及美托洛尔1mg/(kg·d)。随访3个月后患儿的症状改善情况及在HUT过程中血流动力学改善情况。结果治疗前两组患儿性别、年龄、症状评分及在HUT过程中的心率、血压改变相比,差异均无显著性。治疗3个月后治疗组患儿的有效率明显高于对照组(80%vs40%,P<0.05),治疗组患儿治疗后的症状评分及在HUT过程中心率增加的程度较治疗前的基础值均有显著降低[分别为8.20±4.69vs4.70±3.93,P<0.05及(40.35±13.92)次/min vs(27.30±10.18)次/min,P<0.01];与对照组相比,治疗组在HUT过程中心率增加的程度也显著降低[(27.30±10.18)次/min vs(38.80±11.69)次/min,P<0.05]。长期随访过程中的治疗组患儿疗效稳定,未发现明显的不良反应。结论β-受体阻滞剂联合口服生理盐水可有效地治疗体位性心动过速综合征。

Objective To observe the effect of β receptorl blocker plus oral saline on the treatment of postural orthostatic tachycardia syndrome （POTS） in children. Methods Thirty children with POTS diagnosed based on head-up tilt test （HUT） were divided into treatment group （n = 20） or control group （n = 10）. Oral saline （250 ml bid） was given to children in control group while metoprolol （lmg/kg · d） plus oral saline were given in treatment group. HUT and symptoms burden were examined again after treatment for 3 months. Results There were no significant differences in gender, age, symptoms burden, heart rate and blood pressure between the two groups before treatment. But, After 3 months of treatment, the effective rate in patients received metoprolol plus oral saline was significantly higher than that in patients only with saline（80% vs 40%, P〈0.05）. The symptoms burden score also significantly decreased after administration in treatment group （8. 20 ± 4.69 vs 4.70 ± 3.93, P 〈 0.05）. With no significant change in blood pressure. The increase of heart rate at 3min during HUT in treatment group was significantly lower than that in control group （27, 30 ±10.18 vs 38.80 ± 11.69, P 〈 0.05） . After long-term follow-up, there was no significant side effects in metoprolol treatment. Conclusions Metoprolol plus oral saline is effective in treatment of POTS in children with few side effects.