儿童舌下含化硝酸甘油直立倾斜试验后心率恢复情况

Change of heart rate recovery after sublingual nitroglycerin head-up tilt table test in children

目的探讨儿童舌下含化硝酸甘油直立倾斜试验（SNHUT）后的心率恢复（HRR）变化。方法收集2000年1月至2012年8月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的不明原因晕厥、头痛、头晕、胸闷、叹气等儿童2089例次，年龄2．0～17．9（10．8±2．9）岁，行直立倾斜试验（HUTT），其中行SNHUT1286例。根据HRR结果分HRR正常组（1226例，男657例，女569例）和HRR异常组（60例，男35例，女25例；其中〈12岁47例，≥12岁13例；SNHUT阴性36例，血管抑制型血管迷走性晕厥24例）。比较2组儿童的年龄、静息心率、SNHUT心率峰值、平卧后1min心率、体质量指数等指标有无统计学差异。结果1．HR，R异常发生率为4．67％（60／1286例），男女比较差异无统计学意义（5．06％比4．21％，x2=0．518，P〉0．05）；年龄〈12岁较年龄≥12岁HRR异常发生率明显增高（5．79％比2．74％，x2=6．241，P〈0．05）；SNHUT阴性与SNHUT阳性比较差异无统计学意义（4．25％比5．54％，x2=1．081，P〉0．05）。2．HRR异常组年龄小于HRR正常组（t=3．605，P〈0．01）；HRR正常组的静息心率、平卧后1min心率明显低于HRR异常组（t=-3．308、-9．181，P均〈0．01）；HRR正常组的SNHUT心率峰值、心率储备率明显高于HRR异常组（t=8．785、11．861，P均〈0．01）；HRR异常组与HRR正常组体质量指数比较差异无统计学意义（t=-0．454，P〉0．05）。结论行SNHUT儿童HRR异常发生率为4．67％，多见于12岁以下儿童。临床医师应警惕存在HRR异常者发生心血管事件及心源性猝死。

Objective To investigate the change of heart rate recovery （HRR） after sitblinguai nitroglycerin head-up tilt table test（SNHUT） in children. Methods Two thousand and eighty-nine cases [ aged 2.0 - 17.9 years old, mean（ 10.8 ± 2.9） years old] were enrolled in this study, who came from children syncope outpatient department or inpatient department of the Second Xiangya Hospital of Central South University from Jan. 2000 to Aug. 2012, complaining of unexplained syncope, presyncope, headache, dizziness, chest tightness, sigh etc, which turned out to be headup tilt table test （HUTT）, of which 1 286 children took SNHUT. According to the result of HRR in SNHUT, the children were divided into 2 groups of HRR normal group （ n = 1 226, male 657 cases, female 569 cases） and HRR abnormal group（n = 60, male 35 cases ,female 25 cases ; 〈 12 years old 47 cases, ~ 12 years old 13 cases ; SNHUT negative 36 cases and vascular inhibited type vasovagal syncope 24 cases）. The 2 groups of children were compared in age, resting bean rate, SNHUT maximum heart rate, the 1 rain heart rate after prostration, and body mass index, etc. Results 1. HRR abnormal rate was 4. 67% （60/1 286 cases ）. There was no significant difference between boys and girls （5.06% vs 4. 21%, X2 = 0.518,P 〉 0.05 ） ;there was increasing significance in 〈 12 years old group than ≥ 12 years old group（5.79% vs 2.74%, X2 = 6. 241, P 〈 0. 05 ） ; there was no significant difference between SNHUT negative group and SNHUT positive group （4.25 % vs 5.54%, X2 = 1.081, P 〉 0.05 ）. 2. The age of HRR abnormal was younger than HRR normal group（t = 3. 605 ,P 〈 0.01 ）. Resting heart rate and the 1 rain heart rate after prostration were increased in HRR abnormal group compared with HRR normal group（ t = - 3. 308, - 9. 181, all P 〈 0. 01 ） ; Peak heart rate of SNHUT and the heart rate reserve requirements were lower in HRR abnormal group compared with HRR normal group （ t = 8. 785,11.861, all P 〈 0. 01 ） ; there was no significant difference of body mass index between HRR abnormal group and HRR normal group （ t = - 0. 454, P 〉 0.05 ）. Conclusions The children＇ s abnormal rate of HRR with SNHUT was 4. 67% ,mostly in children under 12 years old. Clinicians should be alert to the occurrence of cardiovascular events and sudden cardiac death in HRR abnormal.