血管迷走性晕厥儿童直立倾斜试验过程中心电图T波振幅对非药物治疗近期疗效的预测价值

Predictive value of T wave amplitude in short - term curative effect of nonpharmacological therapy of vasovagal syncope （ WS ） children during head - up tilt test

目的研究直立倾斜试验（HUTF）过程中肢导联心电图T波振幅（TWAh）在血管迷走性晕厥（VVS）儿童非药物治疗不同效果之间的差异，探讨TWAh对VVS儿童非药物治疗效果的预测价值。方法2007-01～2009—11在我院儿童晕厥专科门诊就诊或住院的不明原因晕厥（unexplainedsyncope，ups）或先兆晕厥并经HUTT阳性确诊为VVS儿童62例。HUTT时监测肢导联心电图并同时描记TWAh，给予非药物治疗，2周后来我院复查HUTT。根据HUTT复查结果将儿童分为疗效明显组和疗效不明显组，比较TWAh在疗效明显组和疗效不明显组的差异。结果①HUTT过程中TWAh与HUTT时间点的关系：Ⅱ、aVR、aVF导联相继从基础直立倾斜试验（BHUT）阶段1min、10min及30min起，在两组间TWAh比较差异均有统计学意义（P〈0．05）。②肢导联T波振幅变化幅度（ATWAh）与HUTT时间点的关系：Ⅱ导联ATWAh在BHUT阶段1min及35min时，疗效明显组与疗效不明显组比较差异有统计学意义（P〈0．05）；aVR导联△TwAh在BHUT阶段15min及35min时，疗效明显组与疗效不明显组比较差异有统计学意义（P〈0．05）；aVF导联△TwAh在BHUT阶段35min时，疗效明显组与疗效不明显组比较差异有统计学意义（P〈0．05）。③TWAh与VVS儿童非药物治疗效果的关系：Ⅱ、aVR、aVF导联相继从BHUT阶段1main、10min及30min起，TWAh与治疗效果存在相关性。④ATWAh与VVS儿童非药物治疗效果的关系：HUTT晕厥发作时Ⅱ导联ATWAh与治疗效果存在相关性（P〈0．05）。结论Ⅱ、aVR、aVF导联TWAh对VVS儿童近期非药物治疗效果存在一定预测价值。

Objective To investigate the difference of T - wave amplitude in limb - lead electrocardiogram （TWAh） during head - up tilt test （HUTY） between the vasovagal syncope （VVS） patients with different curative effects of nonpharmacological therapy and its predictive effect. Methods Sixty-two children [32 men, 30 women, 6- 17 years old, mean （10.80±2.59） years old] were enrolled in this study, who came from children syncope out - patient department or in - patient department of the Second Xiangya Hospital of Central South University from January 2007 to November 2009, complaining of syncope or pre - syncope symptoms. All these patients took HUTT. Each patient＇s limb - lead electrocardiogram was recorded during HUTT. TWAh were measured and difference of TWAh alteration in limb - lead electrocardiogram during HUTT （ATWAh） were calculated after HUTT. Each patient with the diagnosis of VVS by positive HUTT was given nonpharmacological therapy including health education, tilt training （30 min per. time, twice a day）, ORS treatment （14.75 g/d, dissolved into 500 mL water, oral application by times）. Each patient was told to recheck the HUTT two weeks later. The patients were divided into two groups according to the results of HUTT： the effective group （n = 45 ） and the inefficient group （n = 17 ）. Results （1）TWAh between effective group and inefficient group： TWAh of Ⅱ lead since 1 min of BHUT, and aVR lead since 10 min of BHUT, and aVF lead since 30 min of BHUT, which was significantly decreased in effective group compared with the inefficient group （ P 〈 0.05 ） ; there＇s no significant difference between two groups at any other time on any other leads. （2）△TWAh between effective group and inefficient group： △TWAh on Ⅱlead at 1 min and 35 rain of BHUT was significantly different between effective group and inefficient group （ P 〈 0.05 ） ; △TWAh on aVR lead at 15 min and 35 rain of BHUT was significantly different between effective group and inefficient group （ P 〈 0. 05 ） ; △TWAh on aVF lead at 35 rain of BHUT was significantly different between effective group and inefficient group （ P 〈 0.05 ）. （3）Relationship between TWAh and curative effect of nonpharmacological therapy： the curative effect of nonpharmacological treatment was associated with TWAh of Ⅱ lead since 1 min of BHUT, and aVR lead since 10 min of BHUT, and aVF lead since 30 min of BHUT （ P 〈 0.05 ）. （4）Relationship between ATWAh and curative effect of nonphannacological therapy ： the curative effect of nonpharmaeological therapy was associated with ATWAh on Ⅱ lead when syncope occurred（P 〈0. 05 ）. Conclusion TWAh is a predictor of curative effect of nonpharmacological therapy in VVS children.