舌下含服硝酸甘油激发直立倾斜试验在儿童晕厥的诊断价值

目的：探讨舌下含服硝酸甘油激发直立倾斜试验（SNHUT）在儿童晕厥中的诊断价值。方法2013年1月至2015年12月因晕厥行直立倾斜试验的儿童共49例，收集相关临床资料，进行诊断学研究及血流动力学监测。结果49例晕厥患儿经直立倾斜试验诊断，36例阳性，13例阴性，基础直立倾斜试验（BHUT）和SNHUT诊断阳性率分别为53.1%、73.5%，出现阳性反应时间分别为（13.38＆#177;11.66）min、（7.50＆#177;3.54）min；36例阳性儿童中，体位性心动过速综合征13例（26.5%），直立性低血压4例（8.2%），直立性高血压2例（4.1%），血管迷走性晕厥血管抑制型11例（22.4%），心脏抑制型2例（4.1%），混合型4例（8.2%）；舌下含服硝酸甘油儿童共23例，未见明显不耐受或其他不良反应。结论 BHUT及SNHUT有助于晕厥分型诊断，SNHUT能提高BHUT诊断阳性率、缩短反应时间，不良反应少。

ObjectiveTo discuss the diagnostic value of head-up tilt test potentiated with sublingual nitroglycerin in children’s syncope. MethodsData of 49 children who came from hospitalization with syncope whose clinical features were collected and the hemodynamic pattern was analyzed in January 2013 ~ December 2015.ResultsA total of 49 children were selected. After being diagnosed with head-up tilt test,36 children were positive,the positive rate of diagnosis BHUT was 53.1% and SNHUT was 73.5%. The syncope episodes occurred after standing time（13.38＆#177;11.66） min in BHUT and（7.50＆#177;3.54）min in SNHUT. In positive children,postural orthostatic tachycardia syndrome comprised 13（26.5%）,orthostatic hypotension 4（8.2%）,orthostatic hypertension 2（4.1%）,vasovagal syncope vasoinhibitory pattern 11（22.4%）,cardioinhibitory pattern 2 （4.1%）,and the mixed pattern 4（8.2%）. There were no intolerance cases and other side effects in 23 children with sublingual nitroglycerin. ConclusionTo the children with syncope,we could use BHUT and SNHUT to diagnose and judge the hemodynamic patterns. SNHUT can improve the diagnostic positive rate of BHUT and the time of positive response occurrence is shorter with less side effects.