口服补液盐治疗血管迷走性晕厥疗效及与血流动力学类型的关系

The effects of oral rehydration salts on the treatment of children vasovagal syncope and hemodynamic types

目的观察口服补液盐治疗血管迷走性晕厥(VVS)的临床疗效,并评价其对不同血流动力学类型VVS患者的影响。方法采用前瞻性研究方法,选择2013年9月至2016年6月东莞东华医院收治的80例VVS患者作为研究对象,采用随机数字表法随机分为两组,对照组(n=25)给予健康教育,观察组(n=55)在健康教育基础上给予口服补液盐治疗。比较两组患者直立倾斜试验(HUTT)转阴率、平卧血压和心率;另外根据不同血流动力学类型,观察组又分为血管抑制型(n=29)和混合型及心脏抑制型(n=26),观察口服补液盐对不同血流动力学类型VVS患者的影响;对照组和观察组治疗6个月后若无晕厥或晕厥先兆发展则停止治疗并随访12个月,观察晕厥或晕厥先兆复发率。结果治疗6个月后,观察组HUTT转阴率(70.9%)明显高于对照组(24.0%),差异有显著性(P<0.05);两组患者治疗前后的平卧血压和心率差异均无统计学意义(P>0.05),但两组患者治疗后的HUTT过程中倾斜开始与基础平卧位血压和心率差值的变化差异均有统计学意义(P<0.05);随访12个月,观察组的晕厥或晕厥先兆复发率(43.6%)明显低于低于对照组(68.0%),差异有显著性(P<0.05);血管抑制型HUTT转阴率(79.3%)、随访晕厥或晕厥先兆复发率(34.5%)略优于混合型及心脏抑制型(61.5%,53.8%),但差异均无统计学意义(P>0.05)。结论口服补液盐治疗VVS的疗效要优于单纯健康教育;口服补液盐适用于不同血流动力学类型VVS患者,疗效相似。

Objective To observe the curative effect of oral rehydration salts on pediatric vasovagal syncope(VVS)and evaluate its effects on patients with different hemodynamic types VVS.Methods By using the prospective study method,80 cases of VVS patients from September 2013 to June 2016 in Dongguan Tung Wah Hospital were selected as the object of study,who were randomly divided into two groups.The control group(n=25)received health education,the observation group(n=55)on the basis of health education received the treatment of oral rehydration salts.Head up tilt test(HUTT)negative rate,blood pressure and heart rate in addition to procumbent were compared between the two groups.According to different hemodynamic patterns,the observation group was divided into vasodepressive type and mixed type(n=29)and cardioinhibitory type(n=26).To observe the effects of oral rehydration salts on different hemodynamic patterns in VVS patients and control group;the observation group after 6 months of treatment without syncope or presyncope development stop treatment and follow-up of 12 months,to observe the recurrence rate of syncope or presyncope.Results After 6 months of treatment,HUTT of the observation group negative rate(70.9%)was significantly higher than that of the control group(24.0%),there was significant difference(P<0.05).The blood pressure and heart rate of horizontal difference before and after treatment in two groups were not statistically significant(P>0.05),but there were statistically significant differences in changes of HUTT of two groups after treatment.Start with the basic tilt supine blood pressure and heart rate difference(P<0.05).After 12 months of follow-up,syncope or presyncope recurrence rate(43.6%)of the observation group was significantly lower than that in the control group(68%).There was significant difference(P<0.05);vasodepressive type HUTT negative rate(79.3%),follow-up of syncope or syncope with the recurrence rate(34.5%)were slightly better than that of mixed type and the inhibition of heart(61.5%,53.8%),but the differences were not statistically significant(P>0.05).Conclusion The therapeutic effect of oral rehydration salts on pediatric VVS is better than that of education.Oral rehydration salts are applicable to children with different hemodynamic types VVS.