摘要
目的总结小儿心源性晕厥病例的治疗经验。方法研究对象为1997年1月至2008年3月广东省人民医院收治的心源性晕厥患儿57例，其中男25例，女32例；年龄平均（3．0±3．9）岁（0．6～14岁）。35例法洛四联症缺氧发作晕厥的病例予B受体阻滞剂及心脏手术治疗。9例Ⅲ度房室阻滞晕厥病例予心室起搏及针对基础心脏疾病治疗。5例长QT综合征（LQTS）晕厥发作的病例分别予美西律、β受体阻滞剂及联合起搏治疗。致心律失常性右室心肌病及扩张型心肌病室性心动过速晕厥的病例予电击复律、索他洛尔、胺碘酮等治疗。室颤及电机械分离病例予除颤等复苏急救及治疗原发心脏病。患儿出院后均予随诊。结果50例住院期间晕厥得到控制，住院期间死亡3例。本组随访时间1个月至10年，5例出院后失访。随访中45例无晕厥发作，1例晕厥发作减少，2例仍反复发作，1例死亡。结论心源性晕厥除治疗引发晕厥的直接因素外，还应积极治疗原发心脏疾病。单纯药物治疗只对部分病倒有效，药物联合起搏或联合植入型心脏复律除颤器有望在恶性心律失常晕厥病例治疗中发挥重要作用。
Objective To summarize the therapy experienee of eardiogenie syncope in children. Methods A total of 57 children （32 females,25 males） with cardiogenic syncope were involved in this study： 35 eases with tetralogy of Fallot suffering from syncope because of anoxic spell underwent beta-receptor blocker treatment and cardiac operation;9 eases with paroxysmal syncope caused by acute complete atrial ventricular block underwent ventrieular pacing and the corresponding treatment to primary cardiac disorder;5 eases with long QT syndrome and Torsades de pointes underwent betareceptor blocker, mexiletine, and pacemaker followed by beta-receptor blocker therapy, respectively. The children with ventricular taehycardia and cardiomyopathy underwent electrical cardioversion, sotalol or amiodarone treatment. The patients who suffered from ventricular fibrillation or electromechanical dissoeiaton received routine resuscitation. All patients underwent follow-up study. Results Four patients died in this study and 50 cases were improved. In the follow-up study for 1 month to 10 years,45 eases were free from syncope. Conclusion The treatment to cardiogenie syncope should include therapy to the direct cause of syncope such as arrhythmia and to the basic cardiac disorder. Simple pharmacotherapies are effective only in a few patients. Medications combined with pacing are available to some syncope cases with severe arrhythmia. To some cases with lethal arrhythmia,implantable cardioverter defibrillator should be considered.
出处
《中国实用儿科杂志》
CSCD
北大核心
2008年第11期836-838,共3页
Chinese Journal of Practical Pediatrics
