儿童体位性心动过速综合征美托洛尔和盐酸米多君治疗118例报告

Therapies for postural tachycardia syndrome in children

目的 比较口服补液盐、口服补液盐联合美托洛尔或口服补液盐联合盐酸米多君治疗儿童体位性心动过速综合征（postural tachycardia syndrome,POTS）的短期及长期疗效.方法 118例POTS患儿分为口服补液盐组（39例）、美托洛尔组（口服补液盐联合美托洛尔,10例）和盐酸米多君组（口服补液盐联合盐酸米多君,69例）.对患儿进行门诊或电话随访,随访时间3～18个月,平均（11.7±4.1）个月.比较3组患儿3个月内的有效率来评价短期疗效,以无效为终点事件,作KaplanMeier曲线比较3组患儿的长期疗效.结果 3组POTS患儿治疗3个月后与随访结束时的临床症状较治疗前均有明显改善.3组患儿的短期疗效从高到低依次为盐酸米多君组（91.3%）、美托洛尔组（80.0%）和口服补液盐组（74.4%）,其差异有统计学意义（x2=5.85,P＜0.05）.盐酸米多君组的长期疗效明显优于口服补液盐组和美托洛尔组（P＜0.05）,后两者之间差异无统计学意义（P＞0.05）.结论 口服补液盐联合盐酸米多君或口服补液盐联合美托洛尔能提高儿童POTS的疗效,并且盐酸米多君的疗效较美托洛尔更为显著.

Objective This study was designed to compare the short-term and long-term effects of oral rehydration salts,oral rehydration salts plus metoprolol or oral rehydration salts plus midodrine hydrochloride on the treatment of postural tachycardia syndrome（POTS）in children.Method A total of 118 children with POTS were divided into oral rehydration salts group（n=39）,metoprolol group（oral rehydration salts plus metoprolol,n=10）or midodrine hydrochloride group（oral rehydration salts plus midodrine hydrochloride,n=69）.The patients were followed up in clinics or over telephone for 3-18months,with a mean of（11.7±4.1）months.The symptom scores were recorded before treatment.after 3months and at the end of the follow-up.Reduction of the score by 2 points or more was considered that the treatment was effective.The effective rate in 3 months was applied to evaluate short-term effects of 3 different therapies by chi-square test.Taking futility as events,Kaptan-Meier curves were drawn to compare long-term effects of the 3 different therapies in treating POTS in children.Resuit No significant differences among the 3 groups were found in sex,age,body height,weight,the symptom scores before treatment or hemodynamic variables.Oral rehydration salts,metoprolol and midodrine hydrochloride improved clinical symptoms after 3months.The symptom scores of the 3 groups before treatment and after 3 months were 2.4±3.2 vs.5.5±2.9.2.2±3.0 vs.6.1 ±3.0 and 1.9±1.6 vs.5.9 ±2.7.respectively.The difference was significant （P＜0.05）.Descending order of the short-term effective rate was 91.3%in midodrine hydrochloride group,80.0% in metoprolol group and 74.4% in oral rehydration salts group.The difference was significant（X2=5.85,P＜0.05）.All the 3 different therapies improved clinical symptoms at the end of follow-up.The symptom scores were 2.6 ±3.2 vs.5.6 ±2.9,2.5 ±3.1 vs.6.1±3.0 and 2.2±2.1 vs.6.0 ±2.7.respectively.（P＜0.05）.The result of the Kaplan-Meier curves showed that the long-term effect of midodrine hydrochloride was significantly superior to metoprolol group and oral rehydration salts group（P＜0.05）.There was no significant difference between the latter two groups.Conclusion Oral rehydration salts plus midodrine hydrochloride or plus metoprolol improved the efficacy of drugs in children with POTS.And the efficacy of midodrine hydrochloride was superior to that of metoprolol.