摘要
目的探讨心率及血压变异系数在可疑直立不耐受(OI)患儿快速识别中的临床应用价值。方法回顾性研究。选取2015年1月至2020年1月山东大学齐鲁医院儿科诊治的379例因OI症状入院患儿为病例组;选取20名无晕厥及晕厥先兆症状的门诊健康查体儿童为无症状对照组。病例组根据直立试验及直立倾斜试验(HUTT)结果分为HUTT阴性组、血管迷走性晕厥(VVS)组、体位性心动过速综合征(POTS)组、POTS合并VVS组。分析所有入组儿童试验过程中的血压及心率数据,分别计算各组研究对象卧立位及卧立倾斜位收缩压变异系数(SBPCV)、舒张压变异系数(DBPCV)及心率变异系数(HRCV)。5组研究对象各项指标的组间比较采用Kruskal-Wallis检验,组间两两比较采用Dunnett′s T3法;5组内卧立位与卧立倾斜位变异系数比较采用配对样本t检验。通过受试者工作特征(ROC)曲线对卧立位心率及血压变异系数的预测价值进行评估。结果379例患儿中,HUTT阴性组79例、VVS组208例、POTS组52例、POTS合并VVS组40例,无症状对照组20名。无症状对照组、HUTT阴性组、VVS组、POTS组、POTS合并VVS组患儿卧立位SBPCV分别为(3.8±1.0)%、(5.3±2.2)%、(6.6±3.4)%、(5.9±3.6)%、(6.9±2.8)%,卧立倾斜位SBPCV分别为(4.5±0.8)%、(6.0±1.9)%、(7.1±2.6)%、(6.0±2.1)%、(7.3±2.5)%,卧立位DBPCV分别为(7.3±1.2)%、(9.1±3.7)%、(9.1±4.9)%、(9.1±4.8)%、(11.6±4.6)%,卧立倾斜位DBPCV分别为(7.4±1.1)%、(9.4±2.9)%、(10.1±3.8)%、(9.2±3.3)%、(11.0±4.7)%,卧立位HRCV分别为(7.6±2.6)%、(12.9±3.7)%、(16.2±4.3)%、(21.2±5.9)%、(24.9±5.3)%,卧立倾斜位HRCV分别为(8.1±1.6)%、(10.1±2.7)%、(14.1±4.3)%、(15.6±3.7)%、(18.9±4.0)%,各项指标的5组间比较差异均有统计学意义(χ^(2)=21.91、25.47、19.82、14.65、104.52、92.51,均P<0.05);ROC曲线分析显示当卧立位SBPCV及HRCV分别为4.4%及10.5%时,曲线下面积分别为0.713及0.877,其对HUTT阴性组预�
Objective To investigate the clinical value of coefficient of variation of heart rate and blood pressure in rapid identification of children with suspected orthostatic intolerance(OI).Methods This was a retrospective study.The medical records of 379 children with OI were collected,who were admitted to the Department of Pediatrics of Qilu Hospital of Shandong University from January 2015 to January 2020.Another 20 out-patient children without syncope or syncope aura were selected as control.According to the results of standing test and head-up tilt test(HUTT),all the patients with OI were divided into the following 4 groups:vasovagal syncope(VVS)group,postural tachycardia syndrome(POTS)group,POTS combined with VVS(POTS+VVS)group and HUTT negative group.Then,coefficient of variation of systolic pressure(SBPCV),coefficient of variation of diastolic pressure(DBPCV)and coefficient of variation of heart rate(HRCV)in standing test and HUTT were calculated.Kruskal-Wallis test was used for comparison among the five groups,and Dunnett′s T3 method for comparison between two groups.Paired t test was used to compare the coefficient of variation between supine and erect position and tilt position in each group.The predictive values of HRCV,SBPCV and DBPCV for negative HUTT were evaluated by receiver operating characteristic(ROC)curve.Results Among the 379 children,there were 79 in HUTT negative group,208 in VVS group,52 in POTS group,and 40 in POTS+VVS group.The SBPCV of supine-erect position of the control group,HUTT negative group,VVS group,POTS group,POTS+VVS group were(3.8±1.0)%,(5.3±2.2)%,(6.6±3.4)%,(5.9±3.6)%,(6.9±2.8)%,respectively.Similarly,the SBPCV of supine,erect and head-up tilt position were(4.5±0.8)%,(6.0±1.9)%,(7.1±2.6)%,(6.0±2.1)%,(7.3±2.5)%;the DBPCV of supine-erect position were(7.3±1.2)%,(9.1±3.7)%,(9.1±4.9)%,(9.1±4.8)%,(11.6±4.6)%;the DBPCV of supine,erect and tilt position were(7.4±1.1)%,(9.4±2.9)%,(10.1±3.8)%,(9.2±3.3)%,(11.0±4.7)%;the HRCV of supine-erect position were(7.6±2.6)%,(1
作者
孔清玉
赵翠芬
王敏敏
赵海招
Kong Qingyu;Zhao Cuifen;Wang Minmin;Zhao Haizhao(Department of Pediatric Cardiology,Qilu Hospital of Shandong University,Jinan 250012,China)
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2022年第1期25-29,共5页
Chinese Journal of Pediatrics
基金
山东省重点研发计划公益项目(2019GSF108186)。
关键词
晕厥
心率
血压
儿童
Syncope
Heart rate
Blood pressure
Child
