摘要
目的提出简单实用的符合我国儿童特点的晕厥诊断程序,并且联合全国多家医院进行多中心应用研究,以验证其是否可提高对晕厥儿童的诊断效率,降低诊断成本。方法2004年10月至2006年6月在北京、湖南、湖北三地5家医院就诊或住院的不明原因晕厥或接近晕厥患儿共474例(男212例,女262例;年龄平均12岁)严格按照制定的儿童晕厥诊断程序进行诊断。诊断程序主要包括2个步骤,第1步为最初的评价;第2步通过对提示诊断者进一步的检查。结果经过第1步的诊断程序评价,共有59例患儿得出明确诊断(59/474,12.4%),54例患儿提示可能的晕厥病因(54/474,11.4%)。经过第2步的诊断程序评价,共有326例患儿明确诊断(326/474,68.7%)。经过整个诊断程序可明确诊断患儿为385例,占81.1%。其中最常见的病因为自主神经介导的晕厥共346例,占73.0%;其次为心源性晕厥共14例,占2.9%;精神性晕厥有11例患儿,占2.3%;10例患儿为神经源性晕厥,占2.1%;4例患儿为代谢性晕厥,占0.8%;68例患儿为诊断不明,占18.9%。结论应用简单、实用的儿童晕厥诊断程序,可有效地提高儿童晕厥的病因学诊断,并可指导合理地应用各种辅助检查。
Objective A simplified diagnostic algorithm in accord with Chinese children was developed and prospectively implemented in five hospitals of china in order to improve the diagnostic performance of pediatrician and decrease the diagnostic cost. Methods The study population included 474 consecutive patients （ 212 males and 262 females, mean age 12 years,ranging 6- 17 years ） presenting with a syncopal spell or presyncopal spell at one of the five participating hospitals from October 2004 June 2006. All patients were evaluated on strict adherence to diagnostic protocol in children with syncope. Results The initial evaluation alone was diagnostic in 59 patients （59/474,12.4% ）, possibly diagnostic in 54 patients, and the others were patients with unexplained syncope. After further tests, a definite diagnosis was established in 326 patients （ 326/474,68.7 % ）. After the whole diagnostic protocol, a definite diagnosis was established in 385 patients （385/474, 81.1%）. Autonomic-mediated reflex syncope accounted for 73.0% of diagnosis, cardiac syncope 2. 9% ,neurological syncope 2. 1% , psychiatric syncope 2. 3%, metabolic syncope 0. 8%, undiagnosed patients 18. 9%. Conclusion The use of simplified, practical diagnostic protocol in children and adolescents with syncope results in an improvement of diagnostic yield.
出处
《中国实用儿科杂志》
CSCD
北大核心
2008年第2期118-121,共4页
Chinese Journal of Practical Pediatrics
基金
国家十五攻关计划(2004BA720A10)
关键词
晕厥
诊断程序
儿童及青少年
Syncope
Diagnostic protocol
Children and adolescents
