儿童急诊不明原因晕厥病因分析及预后情况

Causes Analysis and Prognosis of Syncope in Children in Emergency Department

目的探讨儿童急诊不明原因晕厥病因分析及预后情况。方法选取于2016年2月—2019年2月间鲁山县人民医院急诊收入的1000例不明原因晕厥的儿童,从患儿和患儿家属及晕厥发作时目击者等采集资料,详细询问患儿性别、年龄、病程、发病时间;发作体位、先兆和伴随症状、意识丧失时间、缓解方式;饮食习惯、既往史、家族史等情况,并对患儿进行心脏、神经系统等体格检查;患儿出院后进行3~5年随访。结果1000例不明原因晕厥儿童中,自主神经介导性晕厥患儿802例(包括血管迷走性晕厥患儿401例、体位性心动过速综合征患儿377例、直立性高血压患儿24例),精神性晕厥患儿123例,诊断不明晕厥患儿75例。晕厥女患儿略多于男患儿,且年龄多发于12岁以下,不同类型晕厥患儿性别、年龄及血压差异均无统计学意义(P>0.05)。对患儿进行3~5年随访,结果显示不同类型晕厥患儿反复晕厥发生率较高。结论儿童急诊不明原因晕厥病因以自主神经介导性晕厥最为常见,除明确心源性晕厥外,应与精神性晕厥区别;不明原因晕厥存在诱因,确定其诱因分布,有助于采取有效预防措施防止发生晕厥,减少儿童因晕厥对躯体的意外伤害,以提高预后。

Objective To investigate the causes and prognosis of syncope in children in Emergency Department.Methods 1000 syncope children in Emergency Department of the hospital from February,2016 to February,2019 were enrolled,and various data were collected from sick child,family members and witnesses at the time of the syncope,including gender,age,disease course,onset time,onset body position of children,pre-syncope,concomitant symptoms,consciousness loss time,remission,dietary habits,disease history and family history.Children received systematic physical examinations,and were followed up for 3~5 years after discharge.Results Among 1000 selected children,802 were autonomic mediated reflex syncope,including 401 cases of vaso vagal syncope,377 cases of postural orthostatic tachycardia syndrome and 24 cases of orthostatic hypertension,as well as 123 cases of mental syncope and 75 cases of unknown cause.Among the selected children,syncope was more common in female than in male,and children under 12 year-old had the highest onset rate;Gender,age and blood pressure of different types of syncope were not statistically significant(P>0.05).3~5 years of follow-up showed a high incidence of recurrent syncope in children with different types of syncope.Conclusion Autonomic mediated reflex syncope is the most common cause of unexplained syncope among chil dren in Emergency Department.It should be distinguished from mental syncope in addition to clear cardiogenic syncope;there is an inducement for syncope of unknown cause,and its distribution is determined to help to take effective preventive measures to pre vent syncope occurs,to reduce the accidental injury to the body caused by syncope,and to improve the prognosis of children.