46例小儿周期性呕吐综合征的临床研究

A Clinical Study of 46 Children with Cyclic Vomiting Syndrome

目的分析小儿周期性呕吐综合征（CVS）的临床特点及诊治经验。方法对1995年11月1日至2009年5月30日期间于我院确诊为CVS的46例患儿的临床资料、诊断治疗及随访结果进行分析。结果本组46例患儿,男22例,女24例,平均发病年龄4.5岁（111岁）,平均诊断年龄8.5岁（4.514.5岁）。66%有偏头痛家族史,74%有晕动症史,83%有明显诱因。临床表现为反复发作性呕吐,发作呈突发突止的刻板形式,呕吐可持续数日,2次发作间有完全健康的间歇期。发作期伴有面色苍白、倦怠、顽固恶心、腹痛、头痛、畏光、怕声、眩晕等症状。29例随访5年,5例用丙戊酸钠,5例用塞庚啶,5例用塞庚啶与丙戊酸钠联合治疗,4例用阿米替林、丙戊酸钠和赛庚啶三联治疗;3例用西比灵和塞庚啶联合治疗;用药平均10个月（1.5个月2年）,除3例用药后仍有发作,间歇期延长外,其余基本无发作,其中28%（8/29）转为偏头痛。结论CVS是儿科较常见的疾病,应提高对该病认识,临床上遇到反复发作性呕吐者,且有完全健康间歇期,在排除其他器质性疾病基础上,应考虑到本病的可能。

Objective To analyze the clinical characteristics of children with cyclic vomiting syndrome（CVS）,summarize the clinical experience,and improve the awareness,diagnosis and treatment level of CVS. Methods The clinical data and results of long-term follow-up of the children with CVS were collected and analyzed from 1995 to 2009 in our department. Results Forty-six children were enrolled in the study,including 22 boys and 24 girls. Mean onset age was 4.5 years（ranged from 1 to 11 years）and the mean age at final diagnosis was 8.5 years（ranged from 4.5 to 14.5 years）. Sixty-six and seventy-four percent of patients had family history of migraine and motional sickness respectively,whereas 83% patients had triggers. The clinical manifestation of CVS was severe episodic vomiting. The episodes had a rapid onset and sudden ending,persisted for several hours to days,and were separated by symptom-free intervals. The incidental symptoms were pallor, lethargy,intractable nausea,abdominal pain,headache,photophobia and dizzy. Twenty-nine patients diagnosed were followed up for 5 years at average. Five patients were treated with valproate,4 with cyproheptadine,5 with cyproheptadine and valproate,5 with amitriptyline,cyproheptadine and valproate,and 3 with cyproheptadine and flunarizine. All treated patients recovered mean 10 month（s1.5 months to 2 years）years later and displayed the reduced number of episodes or the severity of episodes except 3 patients. Twenty-eight percent（8/29）of patients progressed to migraine headaches. Conclusion CVS is a relatively common disease in children and awareness of the condition should be in- creased. CVS should be considered when patients had recurrent vomitting and were completely healthy between the two episodes after excluding other pathological conditions.