儿童小心脏综合征临床特点

Clinical characteristics of children with small heart syndrome

目的 探讨儿童小心脏综合征(SHS)临床特点。方法 选择2016年3月至2017年12月,在中山大学孙逸仙纪念医院儿童心血管科接受诊治的8例SHS患儿为研究对象,并纳入SHS组。采用简单随机抽样法,选择同期在同一家医院门诊进行健康体检的8例健康儿童,纳入对照组。回顾性分析这16例受试儿的临床病例资料或体检记录。对2组受试儿一般临床资料、心率波动范围、血压及两侧肺门距中线距离之和等,采用独立样本t检验进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》,所有受试儿的监护人均知情同意。结果 ①2组男性受试儿比例、年龄、体重、身高、体表面积、人体质量指数(BMI)、收缩压及舒张压比较,差异均无统计学意义(P>0.05)。SHS组患儿心率波动范围为(117.9±20.1)次/min,显著大于对照组的(94.8±3.9)次/min;SHS组患儿两侧肺门距中线距离之和为(88.3±10.5)mm,显著短于对照组的(99.3±5.7)mm,并且差异均有统计学意义(t=3.191、P=0.007,t=2.587、P=0.021)。②SHS组8例患儿中,5例(62.5%,5/8)被诊断为消瘦;6例(75.0%,6/8)表现出胸闷、胸痛、心悸、乏力或头晕等临床症状,当其胸闷、胸痛等发作时,心率明显增快,心率波动范围大,血压降低;4例(50.0%,4/8)合并窦性心律不齐。SHS组患儿心肌酶谱检查、24h动态心电图(Holter)及彩色多普勒超声心动图(CDE)检查,均未见特异性异常改变。③SHS组患儿充分休息后,心脏疾病的上述临床症状均可缓解。出院后对其随访18~36个月,均未再出现上述SHS相关临床症状。结论 SHS儿童临床表现多样化。对于胸闷、头晕就诊的体型瘦小儿童,应进行胸部X射线摄片检查,测量心胸比率(CTR),以防止对其SHS的漏诊、误诊。

Objective To investigate the clinical characteristics of small heart syndrome (SHS) in children. Methods A total of 8 children with SHS who were treated in the Cardiovascular department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from March 2016 to December 2017 were selected as research objects and included in SHS group. By using the method of simple random sampling, 8 healthy children who underwent physical examination in the outpatient department of the same hospital in the same period were selected and included in control group. The clinical data or physical examination records of 16 children were analyzed retrospectively. The general clinical data, heart rate fluctuation range, blood pressure and sum of the distance between both hilus pulmonis and the middle line between two groups were statistically compared by independent-samples t test. This study was in line with World Medical Association Declaration of Helsinki revised in 2013, with the informed consent of the guardians of all testees. Results ①There were no significant differences between two groups in proportion of males, age, weight, height, body surface area, body mass index (BMI), systolic blood pressure and diastolic blood pressure ( P >0.05). The range of heart rate fluctuation in SHS group was (117.9±20.1) beats/min, which was higher than that of (94.8±3.9) beats/min in control group;the sum of the distance between both hilus pulmonis and the middle line of SHS group was (88.3±10.5) mm, which was shorter than that of (99.3±5.7) mm in control group, and the differences were statistically significant ( t =3.191, P =0.007;t =2.587, P =0.021).②Among 8 SHS children in SHS group, 5 cases (62.5%, 5/8) were diagnosed as ematiation. Six cases (75.0%, 6/8) presented clinical symptoms, such as chest blockage, chest pain, palpitation, fatigue or dizziness. When chest blockage, chest pain and other possible symptoms attacked in 8 SHS children, their heart rate significantly increased, heart rate fluctuated in a wide range and blood pressure decreased. Four SHS children (50.0%, 4/8) were complicated with sinus arrhythmia. No specific abnormal changes were found of 8 SHS children in myocardial zymogram, 24 h dynamic electrocardiogram (Holter) and color Doppler echocardiography (CDE).③After taken sufficient rest of children in SHS group, the clinical symptoms as mentioned above could be relieved. The SHS pregnant women were followed up for 18 to 36 months after discharged, and no SHS related clinical symptoms were found in them again. Conclusions The clinical manifestations of children with SHS were diversified. For the thin and small children with chest blockage and dizziness, chest X-ray examination should be carried out and the cardiothoracic ratio (CTR) should be measured in order to avoid missed diagnosis and misdiagnosis of SHS.