盐酸米多君对儿童血管迷走性晕厥血流动力学的影响

Effect of midodrine hydrochloride on haemodynamics of vasovagal syncope in children

目的观察盐酸米多君干预前后血管迷走性晕厥（VVS）儿童血流动力学变化，探讨盐酸米多君对VVS患儿血流动力学的影响。方法2007—04～2009—05在中南大学湘雅二医院儿童晕厥专科就诊或住院的6～17岁[平均（11．60±2．83）岁]62例不明原因晕厥（UPS）或晕厥先兆、直立倾斜试验（HUTT）阳性的VVS患儿，分为口服补液盐组（n=36）和盐酸米多君组（n=26），根据HUTT结果评价疗效并监测其血流动力学变化。治疗6个月后，如没有晕厥或晕厥先兆发作则停药并继续随访。结果盐酸米多君组HUTT转阴率与口服补液盐组比较差异无统计学意义（P〉0．05）；盐酸米多君组晕厥及晕厥先兆复发率低于口服补液盐组（P〈0．05）；两组干预前后平卧位血压和心率比较差异无统计学意义（P〉0．05）。盐酸米多君组干预后血压差值（△舒张压）在倾斜起始较基础平卧位显著缩小（P〈0．05）。结论盐酸米多君可减少VVS儿童体位改变时血流动力学变化，改善直立不耐受症状。

Objective To explore the effect of midodrine hydrochloride on haemodynamics of vasovagal syncope （ VVS ） in children. Methods 62 children with unexplained syncope （ UPS ） and prodromata [ aged 6 - 17 years old, mean （ 11.60 ±2.83 ） years old] were randomly assigned into 2 groups ： oresol group （ n = 36 ） and midodrine hydrochloride group （ n = 26 ） , respectively. Repeated head-up tilt testing （HUTF） and at least 6 - month follow - ups were conducted to evaluate the curative effect and the changes of haemodynamics in treating VVS children. Results ①There was no significant difference in the HUTT -based effective rate between oresol group and midodrine hydrochloride group （ P 〉 0.05 ）. ②During the follow - up period, the recurrence rate of syncope was significantly lower in midodrine hydrochloride group than in orcsol group （ P 〈 0.05 ）. ③There were no statistical differences in hemodynamic indexes （ HR, SBP, DBP） on supine position before and after the treatment in two groups （ P 〉 0.05 ）. After midodrine hydrochloride therapy, the effects of midodrine hydroehloride on the changes in diastolic pressures between upright beginning and supine positions was statistically significant （P 〈 0.05 ）. Conclusion Midodrine hydrochloride can stabilize hemodynamics with body position changes, and improve orthostatic tolerance.