摘要
目的探讨口服补液盐（ORS）对儿童急性直立不耐受（AOI）和慢性直立不耐受（COI）的近期疗效比较。方法2008年1月至2012年8月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的AOI与COI儿童146例。男64例，女82例；年龄4～18（11．18±2．52）岁；分AOI组（67例，主诉为晕厥）和COI组[79例，主诉为头晕（38例）、胸闷胸痛（21例）、头痛（10例）、心悸（8例）、叹气（1例）、抖动（1例）]。全部研究对象直立倾斜试验（HUTT）阳性明确诊断。在健康教育基础上予口服ORS干预，治疗14～180（39．77±31．92）d后来院复诊，询问临床症状改善情况及复查HUTT。结果1．临床主观疗效：总有效率78．8％（115／146例），有效率在AOI组与COI组比较差异无统计学意义[76．1％（51／67例）比81．0％（64／79例），x2=3．083，P〉0．05]。2．HuTT血流动力学类型：初诊AOI组与COI组类型比较差异有统计学意义（Z=-3．418，P〈0．05），2组皆以血管迷走性晕厥（VVS）中的血管抑制型为主[64．2％（43／67例）比88．6％（70／79例），x2=12．367，P〈0．05]，但混合型在AOI组较COI组多见[29．9％（20／67例）比6．3％（5／79例），x2=14．134，P〈0．05]，体位性心动过速综合征（POTS）2例在COI组。干预前后血流动力学类型可发生改变。3．HUTT监测客观疗效：HuTT总转阴率为39．0％（57／146例），AOI组和COI组的HUTT转阴率比较差异无统计学意义[31．3％（21／67例）比45．6％（36／79例），x2=3．083，P〉0．05]。4．HUTT阳性发作时间：HurIT阳性组分为基础直立倾斜试验（BHUT）阳性组和舌下含化硝酸甘油倾斜试验（SNHUT）阳性组。AOI及COI的阳性反应时间在治疗前BHUT组（t=-0．184）和SNHUT组（t=0．420）及治疗后BHUT组（t=0．690）和SNHUT组（t=0．145）比较差异无统计学意义（P均〉0．05）；治疗前后HUTT阳性患儿（VVS血管抑制型）HuTT阳性发作时间进行配对比较，2组治疗后较治疗前稍延长，差异无统计学意义[（20．19±10．96）min比（17．31±11．26）min，t=-0．690，P〉0．05；（4．77±1．99）min比（4．38±1．94）min，t=-1．171，P〉0．05）]。结论ORS治疗儿童AOI和COI的近期疗效比较无统计学差异，但ORS能延长AOI和COI儿童的直立不耐受时间。
Objective To explore the recent intervention effect comparison of oresol （ORS） on children with acute orthostatic intolerance（AOI） and chronic orthostatic intolerance（COI）. Methods The study involved 146 children [ 64 cases were male and 82 cases were female, aged 4 - 18 years, mean （ 11.18 ± 2.52） years ] with AOI and COl in the Second Xiangya Hospital of Central South University between Jan. 2008 and Aug. 2012. The children were assigned into 2 groups. They were AOI group（ n = 67, complains of syncope） and COI group [ n = 79, complains of dizziness （ 38 cases）, chest tightness （21 cases）, headache （ 10 cases）, heart palpitations and chest pain （ 8 cases）, sigh （ 1 case） ,and jitter （ 1 case） ]. All of the subjects were diagnosed as AOI or COI by head-up tilt test（HUTT） and given oresol on the basis of health education. Repeat HUTT and follow-up of 14 - 180 days [ mean （39.77 ±31.92） days] were conducted to evaluate the therapeutic effectiveness. Results 1. Subjective clinical curative effect：the total effective rate was 78. 8% （115/146 cases）, and there was no significant difference in the effective rate between AOI group and COI group [ 76.1% （51/67 cases） vs 81.0% （64/79 cases） ,X2 = 3. 083, P 〉 0.05 ]. 2. The HUTT hemodynamic types ： there was significant difference in the HUTT hemodynamic types between AOI group and COI group when first diagnosed （ Z = - 3. 418, P 〈 0.05 ）. Vasodepressor response patients in AOI group were more than in COI group [ 64. 2% （43/67 cases） vs 88.6% （70/79 cases） ,X2 = 12. 367, P 〈 0.05 ] , and mixed response was more in AOI group than COI group [ 29.9 （20/67 cases） vs 6.3% （5/79 cases） ,X2 = 14. 134, P 〈 0.05 ]. Two patients with postural orthostatic tachycardia syndrome （POTS） belonged to COI group. The HUTT hemodynamic type could be changed after treatment. 3. The HUTT-based objective effect ： total HUTT negative conversion rate was 39.0% （ 57/146 cases） ; respectively,in AOI group and COI group,it was respectively 31.3% （21/67 cases） and 45.6% （36/79 cases） （X2 = 3. 083,P 〉 0.05 ）. 4. The comparison of the reaction time of the HUTF-positive patients ： the HUTT-positive patients were divided into 2 groups, the base head-up tilt test （BHUT） group and the sublingnal nitroglycerin tilt table test （SNHUT） group. The positive reaction time of AOI and COI before treatment in BHUT group （ t = - 0. 184 ） and SNHUT group（ t = 0. 420） and after treatment in BHUT group （t = 0. 690） and SNHUT group （t = 0. 145 ） had no statistically significant difference（ all P 〉 0.05 ）. As for the paired comparison of the positive reaction time of the same positive individuals before and after the treatment, the reaction time after the treatment in both the BHUT and the SNHUT groups were lit3e longer than that before the treatment [ respectively （20.19± 10.96） min vs （ 17.31 ± 11.26） min,t = -0.690,P〉0.05;（4.77±1.99） minvs （4.38±1.94） min,t = - 1. 171,P〉0.05]. Conclusions There is no difference of oresol short-term curative effect on the treatment of children with AOI and COI. The treatment with oresol on children with AOI and COl can extend the upright intolerance time.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2014年第1期19-23,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
基金项目：“十二五”国家科技支撑计划（2012BA103803）
湖南省自然科学基金项目（13JJ5014）
湖南省卫生厅课题（B2013-013）
