儿童青少年晕厥疾病谱近30年变化及卫生经济学分析单中心报告

Underlying disease spectrum of syncope in children and adolescents in the past 30 years and health economic analysis: A single center report

目的了解晕厥患儿基础疾病谱，评价晕厥诊断程序在临床上应用的意义及卫生经济学价值。方法选取1985年1月至2014年12月在北京大学第一医院儿科收治的晕厥患儿935例，男421例（45％）．女514例（55％）；年龄1～18岁，平均（11．2±3．1）岁。分析儿童晕厥的基础疾病谱及晕厥诊断程序的卫生经济学价值。结果1985—1994年，神经介导性晕厥（NMS）占6．7％，89．3％晕厥患儿基础疾病未明；1995-2004年，NMS占62％，其中主要包括血管迷走性晕厥（VVS）和体位性心动过速综合征（POTS），不明原因晕厥患儿发生率下降至28．3％；2005-2014年，NMS成为晕厥患儿的主要基础疾病，占80．7％，主要包括VVS及POTS等，心源性晕厥为5.4％，不明原因晕厥为13．9％。晕厥患儿平均住院日较2009年前显著缩短（P〈0．001），晕厥患儿基础疾病诊断费用降低（P=0．048），住院总花费亦显著降低（P〈0．001）。结论随着对儿童晕厥基础疾病的发现，儿童晕厥的基础疾病确诊率不断提高。构成儿童晕厥的基础疾病为VVS及POTS。儿童晕厥诊断程序具有良好的卫生经济学价值。

Objective To analyze the underlying disease spectrum of syncope in children, and evaluate the diagnostic procedures and economic value. Methods A total of 935 children [421 males （45%） and 514 females （55%） , aged 1 - 18 years, mean age （11.2 ± 3.1 ） ] with syncope were chosen from Outpatient and Inpatient Department of Peking University First Hospital from Jan. 1985 to Dec. 2014. The underlying disease spectrum of syncope in children and the economic value of syncope diagnostic procedure were studied. Results From 1985 to 1994, the neutrally mediated syn- cope （NMS） accounted for 6.7% of the syncope children, and 89.3% of syncope ehildren were with unclear reasons. From 1995 to 2004, the NMS accounted for 62%, mainly including vasovagal syncope （VVS） and postural tachyeardia syndrome （POTS） , and the syncope with unclear reasons decreased to 28.3%. From 2005 to 2014, the NMS was the main underlying disease of the syncope, accounting for 80.7%, mainly including VVS and POTS. Cardiac syncope acout- ed for 5.4%. Unexplained syncope decreased to 13.9%. The average length of hospital stay shortened significantly[ （5.3± 3.9） vs. （6.6± 4.4） day, t = 3.964, P 〈 0.001 ]. The diagnosis costs of syncope children were decreased （P = 0.048） , and the total cost of hospitalization was also decreased （P 〈 0.001 ）. Conclusion With the discovery of new diseases, more and more underlying diseases of syncope are diagnosed. VVS and POTS are the most common diseases in syncope of children. The diagnostic procedure has a good economic value.