自主神经介导性晕厥儿童在直立倾斜试验中阳性反应与并发症的早期发现和处理

Early detection and management of positive reactions and complications of neurally mediated syncope in children during head-up tilt test

目的探讨如何早期发现并及时处理自主神经介导性晕厥(NMS)患儿在直立倾斜试验(HUTT)中的阳性反应与并发症。方法回顾分析行HUTT检查阳性确诊NMS患儿的临床资料。结果201例NMS患儿中,男性95例、女性106例,年龄7岁4月~16岁9月,血管迷走性晕厥(VVS)103例、体位性心动过速综合征(POTS)98例。患儿在HUTT中,晕厥再现5例(2.5%),均为VVS;出现并发症200例(99.5%),其中窦性心动过速182例(90.5%)、窦性心动过缓38例(18.9%),包括心率骤升骤降20例(10.0%),心脏停搏2例(1.0%),交界性逸搏心律2例(1.0%),II度房室传导阻滞1例(0.5%),房性早搏1例(0.5%),抽搐2例(1.0%),暂时性失语2例(1.0%)。达到阳性反应后迅速将倾斜床恢复至水平位,晕厥者予以吸氧并抬高及按摩双下肢,心脏停搏者予以胸外心脏按压,部分清醒后予口服牛奶等处理,全部患儿短时间内临床表现消失,意识、心率、血压、心电图恢复正常,无遗留后遗症及死亡病例。181例(90.0%)患儿在HUTT中有晕厥先兆,108例(53.7%)先有晕厥先兆其后达到阳性反应标准,其中103例在晕厥先兆出现后的8分钟内达到阳性反应标准;47例(23.4%)晕厥先兆与到阳性反应几乎同时出现。结论NMS儿童在HUTT时存在一定风险,早期发现并及时处理阳性反应和并发症,是降低试验风险的关键。

Objective To explore early detection and timely treatment of positive reactions and complications of neurally mediated syncope(NMS)children during head-up tilt test(HUTT).Methods Clinical data of children with NMS diagnosed with HUTT positive examination were retrospectively analyzed.Results In 201 NMS patients,there were 95 males and 106 females,aged from 7.33 to 9.75 years old.Of them,98 cases were postural tachycardia syndrome,and 103 cases were vasovagal syncope(VVS).In HUTT test,5(2.5%)cases had syncope who were all VVS,200(99.5%)cases have complications including 182(90.5%)with sinus tachycardia and 38(18.9%)with sinus bradycardia.In all cases with sinus tachycardia and sinus bradycardia,there were 20 cases(10.0%)with sudden rise and drop in heart rate,2(1.0%)with cardiac arrest,2(1.0%)with junctional escape beat,1(0.5%)with II°atrioventricular block,1(0.5%)with atrial prematuem beats,2(1.0%)with convulsions,and 2(1.0%)with temporary aphasia.By lying down immediately,once reached positive reaction,oxygen supply,raising and massaging both lower extremities if syncope occurs,compressing chest if cardiac arrest occurs,partial patients given oral milk after wakefulness,and the manifestations above in all the patients disappeared quickly,consciousness,heart rate,blood pressure,ECG return to normal,and no sequela and death.It showed 90.0%(181/201)presyncope in HUTT,and 53.7%(108/201)had presyncope,after then reached positive response,95%(103/108)of these patients had reached positive response after presyncope in 8 min.There were 23.4%(47/201)presyncope and positive response occurred simultaneously.Conclusion NMS children have risk during HUTT.The key to reduce the risk of test is to recognize and manage the positive reaction and complications in time.