摘要
目的探讨血管迷走性晕厥（VVS）儿童直立倾斜试验（HUTT）中自主神经功能变化，深化儿童VVS的发病机制。方法选择2006—10—2007—10在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的不明原因晕厥（UPS）儿童96例，根据HUTT结果将研究组分为HUTT阳性组和HUTT阴性组。选取年龄、性别匹配的健康儿童28例作为对照组。研究组和对照组均行HuTr检查，HUTT过程中同时行12导联心电图（12ECG）动态监测。结果①57例HuTT阳性儿童中，13例表现为基础直立倾斜试验（BHUT）阳性，平均反应时间（24．62±5．94）min；44例表现为舌下含化硝酸甘油倾斜试验（SNHUT）阳性，平均反应时间（5．27±1．89）min。②SNHUT阶段1min时HUTT阳性组Ⅲ、aVL、aVF导联P波振幅较HuTr阴性组显著升高（P〈0．05），其余时间段两组比较差异无统计学意义（P〉0．05）。③研究组在HUTT中某些导联T波及ST段振幅较对照组显著降低（P〈0．05），主要表现在V3、V4、V5及V6导联；HUTT阳性组在HuTT中某些导联T波、ST段振幅较HUTT阴性组显著降低（P〈0．05），主要表现在Ⅱ、Ⅲ、aVR、aVL及aVF导联，多发生在HUTT阳性发作平均时间点。④HUTT阳性组晕厥发作时较基础平卧位时P波时间、QRS时间、QT间期显著缩短（P〈0．05，P〈0．01）；与倾斜开始比较，P波时间显著缩短（P〈0．05）；与倾斜5min时比较，各指标无显著变化（P〉0．05）；与试验结束电动倾斜床刚平放时比较，QT间期显著缩短（P〈0．01），而QTC间期显著延长（P〈0．05）。结论VVS儿童存在心脏自主神经功能改变，12ECGT波及ST段振幅变化较P波振幅变化更敏感。
Objective To investigate dynamic changes of synchronous 12 - lead electrocardiogram （ 12 EGG） P wave and ST segment and T wave amplitude in vasovagal syncope （VVS） children during head - up tilt test （HuTr）. Methods 96 children enrolled in this study came from children syncope outpatient department or in - patient department of the Second Xiangya Hospital of Central South University during October 2006 to October 2007. According to the result of HUTT they were further divided into HUTT - positive group and HUTT - negative group. Twenty - eight healthy children were regarded as control group, who were matched at age and gender. All the children experienced HUTT and were monitored dynamically by 12 ECG. All the data were preserved in computer according to clinical samples. Results （1）Among 57 HUTT - positive children, 13 samples showed the positive result at baseline head- up tilt test （BHUT）, mean time was （24. 62 ± 5.94） minutes, while other samples showed the positive result at sublingual nitroglycerin head - up tilt table test （ SNHUT）, mean time .（5.27 ±1.89） minutes. （2）P wave amplitude of HUTT - positive group at 1 - minute SNHUT stage in Ⅲ, aVL, aVF lead were significantly increased than those of HUTT - negative group （P 〈 0. 05）. （3）T wave and ST segment amplitude of syncope group were significantly reduced than those of healthy control group in some leads （ V3, V4, V5 and V6 lead） （ P 〈 0. 05 ）. And T wave and ST segment amplitude were significantly reduced in HUTT -positive group than in HUTI＇ - negative group in some leads （Ⅱ , Ⅲ, aVR, aVL, aVF and V6 lead） at the onset of symptoms （ P 〈 0. 05 ）. （4）P wave duration,QRS duration and QT duration of VVS children at the onset of symptoms were significantly reduced compared with those at baseline （P 〈 0. 05）. P wave duration of VVS children at the onset of symptoms were lower compared with those at the start of tilt （ P 〈 0. 05 ）. There were no significant differences in thfdese indexes at 5 minutes of BHUT （ P 〉 0. 05 ）. QT duration was significantly shortened compared with the end of test （P 〈 0. 01 ）. Conclusion The cardiac autonomic nervous function is abnormal in VVS children, and T wave and ST segment amplitude changes are more sensitive than P wave of 12 ECG.
出处
《中国急救医学》
CAS
CSCD
北大核心
2010年第8期689-693,共5页
Chinese Journal of Critical Care Medicine
