摘要
目的探讨直立不耐受(OI)患儿不同亚型的临床特征及直立倾斜试验(HUTT)中血流动力学特征。方法采用回顾性分析方法,收集2014年9月~2016年3月在浙江大学医学院附属儿童医院心血管内科和陕西省人民医院儿科就诊的363例疑似OI患者病历资料,根据血流动力学改变分型分为体位性心动过速综合征(POTS)组、血管迷走性晕厥(VVS)组、直立性高血压(OHT)组、体位性心动过速综合征合并直立性高血压(POTS合并OHT)组、体位性心动过速综合征合并血管迷走性晕厥(POTS合并VVS)组、直立性低血压(OH)组和正常血流动力学反应(阴性)组。比较分析各亚型临床及血流动力学特征。结果不同亚型OI患者在发病年龄、晕厥先兆出现时间上差异无统计学意义(P>0.05),性别、HUTT试验中阳性体征出现时间、血流动力学参数变化差异有统计学意义(P<0.05)。各亚型HUTT试验中心率、血压变化差异均有统计学意义(P<0.05):POTS组以心率增加为主,但血压变化不大;VVS组以血压下降为主;OHT组以血压尤其舒张压增加为主;POTS合并OHT组心率、血压均上升且幅度较大。此外,阴性患儿占比14.9%,在HUTT试验前后心率、血压变化均有统计学意义(P<0.05)。结论直立不耐受儿童青少年以VVS、POTS类型居多,两型中又以女孩居多。不同亚型在临床特征、血流动力学方面存在差异。疑似POTS、OHT和POTS合并OHT儿童青少年可先行直立倾斜试验,若耐受可适当增加观察时间来区分单一型和合并型。部分筛检阴性的儿童青少年不排除VVS的可能性。
Objective To investigate the clinical characteristics of children and adolescents with different subtypes of orthostatic intolerance(OI)and the hemodynamic characteristics of them in the head-up tilt test(HUTT).Methods The retrospective study was performed to collect the medical records and HUTT result of 363 patients with suspected OI from 2014 to now.The clinical and hemodynamic characteristics of each subtype were analyzed.Results Statistical differences were evidenced in gender,occurrence time of positive signs and changes in hemodynamic parameters(P<0.05)among children with different subtypes of OI.However,there were no significant differences in age and onset time of presyncope(P>0.05).The heart rate(HR)of POTS group increased rapidly but had little change in blood pressure(BP).On the contrary,BP were significantly decreased compared with those before the experiment in patients with VVS.In the OHT group,BP increased rapidly especially diastolic blood pressure(DBP).Both HR and BP increased significantly in patients with POTS combine OHT.In addition,patients with negative results accounted for 14.9%,statistical difference were observed in HR and BP changes after HUTT(P<0.05).Conclusion VVS and POTS are the main types of orthostatic intolerance,which occur commonly in female.Dizziness,chest tightness,and other symptoms are helpful for the diagnosis of OI,but not specific.Different subtypes have different clinical and hemodynamic characteristics.Children with suspected POTS,OHT,POTS combined with OHT can be given a head-up test first.If the child tolerates it,the observation time can be appropriately increased to distinguish combined type from monotype.Some children with negative screening results may belong to VVS.
作者
武敏
荚婉茹
王嘉琪
张琦一
王荣花
焦富勇
沈杰
蔺婧
WU Min;JIA Wanru;WANG Jiaqi;ZHANG Qiyi;Wang Ronghua;JIAO Fuyong;SHEN Jie;LIN Jing(Department of Maternal and Child Health, School of Public Health, Xi’an Jiaotong University, Xi’an 710061, China;Department of Pediatrics, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China;Departmentof Pediatrics, Shaanxi Provincial Peoples’ Hospital, Xi’an 710068, China;Department of Cardiology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310051, China)
出处
《西部医学》
2021年第5期687-692,共6页
Medical Journal of West China
基金
国家自然科学基金青年基金(81803263)
浙江省卫生健康委员会科研项目(2020KY612)。
关键词
直立不耐受
直立倾斜试验
临床特征
血流动力学
儿童青少年
Orthostatic intolerance
Head-up tilt test
Clinical characteristics
Hemodynamics
Children and adolescents
