摘要
目的:探讨自主神经介导性晕厥(neurally mediated syncope,NMS)患儿24 h动态血压监测(ambulatory blood pressure monitoring,ABPM)中各项参数的变化,并分析24 h动态血压变化模式对NMS患儿的诊断价值。方法:2007年7月至2008年3月在北京大学第一医院儿科就诊的NMS患儿47例,其中男20例,女27例,年龄平均(11.7±2.8)岁;同时匹配对照组儿童23例,其中男12例,女11例,平均年龄(11.0±3.2)岁。进行血流动力学类型检测,将NMS患儿分为血管迷走性晕厥(vasovagal syncope,VVS)组[共16例,其中男7例,女9例,平均年龄(11.5±2.8)岁]和体位性心动过速综合征(postural orthostatic tachycardia syndrome,POTS)组[共31例,其中男13例,女18例,年龄平均(11.7±2.9)岁]。比较呈现不同血流动力学模式的儿童24 h动态血压中的各项参数的变化及24 h动态血压变化模式对NMS的诊断价值。采用SPSS10.0软件进行统计。结果:POTS组的全天平均舒张压、白天平均舒张压和夜间平均收缩压比对照组分别增高了8.26%、6.66%和6.03%,两组之间差异均有统计学意义(P<0.05),;而VVS组患儿的全天平均舒张压、白天平均舒张压和夜间平均收缩压与对照组相比差异均无统计学意义(P>0.05)。与对照组相比,VVS组和POTS组患儿的收缩压昼夜差值分别减少了35.92%和28.42%,两组之间差异均有统计学意义(P<0.01)。VVS组和POTS组患儿的全天平均收缩压、白天平均收缩压、夜间平均舒张压以及舒张压昼夜差值与对照组相比差异均无统计学意义(P>0.05)。24 h血压波动曲线结果表明,在VVS组及POTS组中,呈现"非勺型"者的比例均明显高于对照组(68.8%vs17.4%,64.5%vs17.4%,P<0.01),但"非勺型"者的比例在VVS组和POTS组中差异无统计学意义(P>0.05)。24 h血压"非勺型"对于诊断NMS的敏感度为66.0%,特异度为82.6%,诊断符合率为71.4%。结论:NMS患儿的自主神经功能调节失衡,24 h动态血压变化模式对NMS具有诊断价值。
Objective：To discuss the variation of parameters in ambulatory blood pressure for neurally mediated syncope （NMS） in children, and to analyze the diagnostic value of ambulatory blood pressure pattern in children with NMS. Methods： Forty-seven children with NMS [ 20 males and 27 females, mean age （11.7 ± 2. 8 ） years ] who came from Peking University First Hospital from July, 2007 to March, 2008 were included in the study. Twenty-three healthy children [ 12 males and 11 females, mean age （ 11.0 ± 3.2） years ] were recruited as control group. And the hemodynamic patterns of NMS were detected. Based on the hemodynamic patterns, they were divided into vasovagal syncope （VVS） group [ 16 children in total, 7 males and 9 females, mean age （ 11.5 ± 2. 8 ） years ] and postural tachycardia syndrome （POTS） group [31 children in total, 13 males and 18 females, mean age （11.7±2. 9） years ]. Parameters of children with different hemodynamic patterns in ambulatory blood pressure and di- agnostic value of ambulatory blood pressure pattern were analyzed. SPSS 10. 0 software was used for the statistical analysis of these data. Results： Mean diastolic pressure of the whole day, mean diastolic pres- sure in the day-time and mean systolic pressure at night in POTS group were higher than those of the con- trol group, reapectively （P 〈 0. 05 ）, and they increased by 8.26%, 6. 66% and 6. 03%, respectively, but there were no significant differences between VVS group and control group （P 〉 0. 05 ）. The systolic pressure differences in the day-time and at night in VVS group and POTS group were lower than those of the control group, respectively （ P 〈 0. 01 ）, and they decreased by 35.92% and 28.42%, respectively.There were no significant differences in the mean systolic pressure of the whole day, mean systolic pres- sure in the day-time, mean diastolic pressure at night and diastolic pressure difference in the day-time and at night among VVS group, POTS group and control group, respec
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2009年第3期343-347,共5页
Journal of Peking University:Health Sciences
基金
国家十五科技攻关课题(2004BA720A10)
首都医学发展基金(2002-23037)~~
关键词
晕厥
自主神经系统
血压测定
儿童
Syncope
Autonomic Nervous system
Blood pressure determination
Child
