儿童晕厥57例临床初步分析

发布时间：2018-02-22 04:52

本文关键词： 儿童晕厥病因学　出处：《广西医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的分析各病因晕厥儿童的临床特点,提高其诊治水平。方法运用2009年中华医学会儿科学分会心血管学组及《中华儿科杂志》编辑委员会制定的儿童晕厥诊断程序收集广西医科大学第一附属儿科门诊2011年8月至2012年12月以“晕厥”来就诊的57例患儿临床资料,以直立试验来初步筛查VVS的方法,对晕厥的病因进行初步诊断,分析各病因晕厥儿童的性别、年龄、晕厥次数、有无晕厥诱因、有无晕厥先兆、晕厥时体位、晕厥时有无肢体抽动、晕厥持续时间小于5min的比例、有无心脏病史。诊断后给予相关治疗指导,第1及第3个月后进行电话回访,询问有无晕厥再发。结果57例患儿中,自主神经介导性晕厥53例,占92.9%,年龄在2-15(10.23±3.58)岁,男30例,女23例,包括血管迷走性晕厥51例和境遇性晕厥2例；心源性晕厥4例,占7.1%，，年龄在0.8-8(5.5±3.3)岁,男4例,包括儿茶酚胺敏感性多形性心动过速1例,室性心动过速1例,室间隔缺损伴右室流出道梗阻1例,法洛四联症1例。自主神经介导性晕厥发病年龄大于心源性晕厥的患儿(均P0.05)；心源性晕厥患儿的晕厥发作次数多于自主神经介导性晕厥的患儿(均P0.05)。自主神经介导性晕厥及心源性晕厥的患儿皆存在诱因,但二者的诱因不同,自主神经介导性晕厥的诱因以持久站立多见,而心源性晕厥以运动多见,两者的差异有统计学意义(P0.05),自主神经介导性晕厥存在先兆及发生在直立体位的情况则多于心源性晕厥(均P0.05)；自主神经介导性晕厥的心脏病史少于心源性晕厥的患儿(均P0.05)。57例患儿均行心电图检查,发现8例异常,再对8例患儿进行动态心电图检查,发现2例有明显异常；心脏超声检查8例,发现异常2例。脑电图检查11例,未见异常。第1及第3月后电话随访,第1及第3月后电话随访,心源性晕厥均有晕厥再发,第1月血管迷走性晕厥患儿无再发率为84.9%,第3月为92.4%。结论(1)自主神经介导的血管迷走性晕厥占晕厥的多数,多发生在11岁以上的青少年,有比较明显的诱因及先兆,一般发生在直立体位,晕厥次数较少。 (2)绝大多数的血管迷走性晕厥是可以治愈的。
[Abstract]:Objective to analyze the clinical characteristics of children with syncope of different etiology and improve their diagnosis and treatment. Methods the diagnosis procedure of children syncope was collected from August 2011 to 2012 in the pediatric outpatient department of the first affiliated department of Guangxi medical university using the cardiovascular section of the Chinese academy of pediatrics and the editorial committee of the Chinese journal of pediatrics in 2009. In December, the clinical data of 57 children with syncope were reported. The primary diagnosis of the etiology of syncope was carried out by using the upright test to screen the VVS. The sex, age, number of times of syncope, whether there were syncope inducements, whether there were syncope precursors, and the posture of syncope in children with syncope were analyzed. There was no limb twitching during syncope, the proportion of syncope duration was less than 5 min, and there was no history of heart disease. After diagnosis, the patients were given relevant treatment guidance. After 1 and 3 months, a telephone call was made to ask if there was any recurrence of syncope. Results among the 57 cases, 53 cases (92.9%) were autonomic nervous mediated syncope, aged 2-1510.23 卤3.58 years old. There were 30 males and 23 females, including 51 cases of vasovagal syncope and 2 cases of situational syncope, 4 cases of cardiogenic syncope (7.1%), 4 cases of male, aged 0.8-85.5 卤3.3 years. There were 1 case of catecholamine-sensitive pleomorphic tachycardia, 1 case of ventricular tachycardia, 1 case of ventricular septal defect with right ventricular outflow tract obstruction, 1 case of ventricular septal defect with right ventricular outflow tract obstruction. One case of tetralogy of Fallot. The onset age of autonomic nervous mediated syncope is greater than that of cardiogenic syncope (P0.05), and the frequency of syncope in children with cardiogenic syncope is more than that of autonomic nerve mediated syncope (P0.05). There are inducements in children with conductive syncope and cardiogenic syncope. However, the inducement of autonomic nervous syncope is different. The inducement of autonomic nerve mediated syncope is more common in standing for a long time, while that in cardiogenic syncope is more frequent in motion. The difference was statistically significant (P 0.05). Autonomic nervous syncope had more symptoms and occurred in orthostatic position than cardiogenic syncope (P0.05), and autonomic nervous mediated syncope had less cardiac history than cardiogenic syncope. The electrocardiogram (ECG) was performed in all the 57 infants (P0.05, P < 0.05). 8 cases were abnormal, 8 cases were examined by dynamic electrocardiogram, 2 cases were abnormal, 8 cases were abnormal by echocardiography, 11 cases were abnormal by EEG, and 1 case was followed up by telephone after March. After the first and March telephone follow-up, the recurrent syncope was found in all patients with cardiogenic syncope. The non-recurrence rate of vasovagal syncope was 84.9% in January and 92.4% in March. Conclusion (1) vasovagal syncope mediated by autonomic nerve is the majority of syncope, which mostly occurs in adolescents over 11 years of age. It has obvious inducement and precursor, usually occurs in upright position, and the number of syncope is less. The vast majority of vasovagal syncope is curable.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R720.597

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