儿童直立倾斜试验操作标准的临床研究

Study on the standard of the operation of children’s head-up tilt test

目的探讨直立倾斜试验基础试验时程、倾斜角度、药物激发对儿童直立倾斜试验结果的影响。方法选取有晕厥病史的患儿223例,择期行直立倾斜试验,按照检查方法随机分为Ⅰ组55例(倾斜60°,基础试验20 min),Ⅱ组57例(倾斜60°,基础试验45 min),Ⅲ组59例(倾斜70°,基础试验20 min),Ⅳ组52例(倾斜70°,基础试验45 min);4组基础试验阴性者(102例)随即行硝酸甘油激发试验,1周后进行异丙肾上腺素激发试验;将试验结果进行对比分析。结果(1)倾斜60°阳性率(55.4%)与倾斜70°阳性率(53.2%)相比组间差异无统计学意义(P>0.05);(2)基础试验20 min阳性率(51.8%)与基础试验45 min阳性率(56.9%)相比组间差异无统计学意义(P>0.05);(3)硝酸甘油激发试验阳性率(25.5%)与异丙肾上腺素激发试验阳性率(17.6%)相比组间差异有统计学意义(P<0.05)。结论儿童直立倾斜试验操作过程建议采用倾斜角度60°、基础试验20 min作为操作标准,首选硝酸甘油作为激发试验用药。

Objective To investigate the influence of test duration,tilt angle and nitroglycerine or isoproterenol stimulation on tilt testing outcomes.Methods A total of 223 children with a history of syncope were enrolled.According to the examination method of basic HUTT,55 patients were randomly divided into groupⅠ(angle 60°,duration 20 min),and groupⅡwas 57(angle 60°,duration 45 min).59 patients in groupⅢ(angle 70°,duration 20 min),groupⅣhad 52 patients(angle 70°,duration 45 min);A total of 102 patients who experienced negative reaction,were followed by nitroglycerin provocative test,one week later Isoproterenol provocative test;the test results were compared and analyzed.Results The positive rate of tilting 60°(55.4%)was not significantly different from that of tilting 70°(53.2%)(P>0.05);there was no significant difference between the the positive rate of the test duration of 25 min(51.8%)and 45 min(56.9%)(P>0.05).But the difference between the positive rate of nitroglycerin provocative test(25.5%)and isoproterenol provocative test(17.6%)was statistically significant(P<0.05).Conclusion The operating standard of tilt angle of 60°and test duration for 20 min was recommended in the basic phase.Nitroglycerin is the first choice for the provoative test.