本文關(guān)鍵詞： 兒童 暈厥 病因?qū)W　出處：《廣西醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析各病因暈厥兒童的臨床特點(diǎn),提高其診治水平。 方法運(yùn)用2009年中華醫(yī)學(xué)會(huì)兒科學(xué)分會(huì)心血管學(xué)組及《中華兒科雜志》編輯委員會(huì)制定的兒童暈厥診斷程序收集廣西醫(yī)科大學(xué)第一附屬兒科門診2011年8月至2012年12月以“暈厥”來(lái)就診的57例患兒臨床資料,以直立試驗(yàn)來(lái)初步篩查VVS的方法,對(duì)暈厥的病因進(jìn)行初步診斷,分析各病因暈厥兒童的性別、年齡、暈厥次數(shù)、有無(wú)暈厥誘因、有無(wú)暈厥先兆、暈厥時(shí)體位、暈厥時(shí)有無(wú)肢體抽動(dòng)、暈厥持續(xù)時(shí)間小于5min的比例、有無(wú)心臟病史。診斷后給予相關(guān)治療指導(dǎo),第1及第3個(gè)月后進(jìn)行電話回訪,詢問(wèn)有無(wú)暈厥再發(fā)。 結(jié)果57例患兒中,自主神經(jīng)介導(dǎo)性暈厥53例,占92.9%,年齡在2-15(10.23±3.58)歲,男30例,女23例,包括血管迷走性暈厥51例和境遇性暈厥2例；心源性暈厥4例,占7.1%，，年齡在0.8-8(5.5±3.3)歲,男4例,包括兒茶酚胺敏感性多形性心動(dòng)過(guò)速1例,室性心動(dòng)過(guò)速1例,室間隔缺損伴右室流出道梗阻1例,法洛四聯(lián)癥1例。自主神經(jīng)介導(dǎo)性暈厥發(fā)病年齡大于心源性暈厥的患兒(均P0.05)；心源性暈厥患兒的暈厥發(fā)作次數(shù)多于自主神經(jīng)介導(dǎo)性暈厥的患兒(均P0.05)。自主神經(jīng)介導(dǎo)性暈厥及心源性暈厥的患兒皆存在誘因,但二者的誘因不同,自主神經(jīng)介導(dǎo)性暈厥的誘因以持久站立多見(jiàn),而心源性暈厥以運(yùn)動(dòng)多見(jiàn),兩者的差異有統(tǒng)計(jì)學(xué)意義(P0.05),自主神經(jīng)介導(dǎo)性暈厥存在先兆及發(fā)生在直立體位的情況則多于心源性暈厥(均P0.05)；自主神經(jīng)介導(dǎo)性暈厥的心臟病史少于心源性暈厥的患兒(均P0.05)。57例患兒均行心電圖檢查,發(fā)現(xiàn)8例異常,再對(duì)8例患兒進(jìn)行動(dòng)態(tài)心電圖檢查,發(fā)現(xiàn)2例有明顯異常；心臟超聲檢查8例,發(fā)現(xiàn)異常2例。腦電圖檢查11例,未見(jiàn)異常。第1及第3月后電話隨訪,第1及第3月后電話隨訪,心源性暈厥均有暈厥再發(fā),第1月血管迷走性暈厥患兒無(wú)再發(fā)率為84.9%,第3月為92.4%。 結(jié)論(1)自主神經(jīng)介導(dǎo)的血管迷走性暈厥占暈厥的多數(shù),多發(fā)生在11歲以上的青少年,有比較明顯的誘因及先兆,一般發(fā)生在直立體位,暈厥次數(shù)較少。 (2)絕大多數(shù)的血管迷走性暈厥是可以治愈的。
[Abstract]:Objective to analyze the clinical characteristics of children with syncope of different etiology and improve their diagnosis and treatment. Methods the diagnosis procedure of children syncope was collected from August 2011 to 2012 in the pediatric outpatient department of the first affiliated department of Guangxi medical university using the cardiovascular section of the Chinese academy of pediatrics and the editorial committee of the Chinese journal of pediatrics in 2009. In December, the clinical data of 57 children with syncope were reported. The primary diagnosis of the etiology of syncope was carried out by using the upright test to screen the VVS. The sex, age, number of times of syncope, whether there were syncope inducements, whether there were syncope precursors, and the posture of syncope in children with syncope were analyzed. There was no limb twitching during syncope, the proportion of syncope duration was less than 5 min, and there was no history of heart disease. After diagnosis, the patients were given relevant treatment guidance. After 1 and 3 months, a telephone call was made to ask if there was any recurrence of syncope. Results among the 57 cases, 53 cases (92.9%) were autonomic nervous mediated syncope, aged 2-1510.23 鹵3.58 years old. There were 30 males and 23 females, including 51 cases of vasovagal syncope and 2 cases of situational syncope, 4 cases of cardiogenic syncope (7.1%), 4 cases of male, aged 0.8-85.5 鹵3.3 years. There were 1 case of catecholamine-sensitive pleomorphic tachycardia, 1 case of ventricular tachycardia, 1 case of ventricular septal defect with right ventricular outflow tract obstruction, 1 case of ventricular septal defect with right ventricular outflow tract obstruction. One case of tetralogy of Fallot. The onset age of autonomic nervous mediated syncope is greater than that of cardiogenic syncope (P0.05), and the frequency of syncope in children with cardiogenic syncope is more than that of autonomic nerve mediated syncope (P0.05). There are inducements in children with conductive syncope and cardiogenic syncope. However, the inducement of autonomic nervous syncope is different. The inducement of autonomic nerve mediated syncope is more common in standing for a long time, while that in cardiogenic syncope is more frequent in motion. The difference was statistically significant (P 0.05). Autonomic nervous syncope had more symptoms and occurred in orthostatic position than cardiogenic syncope (P0.05), and autonomic nervous mediated syncope had less cardiac history than cardiogenic syncope. The electrocardiogram (ECG) was performed in all the 57 infants (P0.05, P < 0.05). 8 cases were abnormal, 8 cases were examined by dynamic electrocardiogram, 2 cases were abnormal, 8 cases were abnormal by echocardiography, 11 cases were abnormal by EEG, and 1 case was followed up by telephone after March. After the first and March telephone follow-up, the recurrent syncope was found in all patients with cardiogenic syncope. The non-recurrence rate of vasovagal syncope was 84.9% in January and 92.4% in March. Conclusion (1) vasovagal syncope mediated by autonomic nerve is the majority of syncope, which mostly occurs in adolescents over 11 years of age. It has obvious inducement and precursor, usually occurs in upright position, and the number of syncope is less. The vast majority of vasovagal syncope is curable.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R720.597

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