摘要
目的认识自主神经介导性晕厥患儿中腹痛等消化道表现的临床意义。方法 2009年1月至2012年3月在北京大学第一医院儿科住院诊断为自主神经介导性晕厥及心因性发作的患儿共108例,对患儿发作前及直立倾斜试验(HUT)中诱发的腹痛、恶心、呕吐等消化道症状进行临床研究。结果 108例患儿中,男49例(45.4%),女59例(54.6%)。年龄5～17岁(中位年龄11岁)。共33例(35.5%)自主神经介导性晕厥患儿在发作前出现胃肠道不适,15例(16.1%)表现为腹痛,20例(21.5%)恶心,12例(12.9%)呕吐。27例(40.9%)在HUT时诱发出胃肠道表现,6例(9.1%)HUT时诱发出腹痛,24例(36.4%)恶心。共39例(59.1%)在发作前或HUT时出现消化道表现。HUT时出现的消化道表现在体位性心动过速综合征(POTS)患儿和血管迷走性晕厥(VVS)患儿分别达到40%及41.5%,心因性发作组为0;发作前及HUT时患儿消化道表现在POTS及VVS组分别达到60%及58.5%,明显高于心因性发作(10%)组(P<0.05)。自主神经介导性晕厥患儿发作前及HUT时出现消化道症状的危险度是心因性发作患儿的13倍(95%CI均>1)。结论消化道表现是自主神经介导性晕厥的常见症状之一,对于发作前及HUT时发生腹痛、恶心患儿,需注意自主神经介导性晕厥的可能。剧烈腹痛可作为自主神经介导性晕厥的伴随症状。
Objective To investigate the clinical significance of abdominal pain and other gastrointestinal manifesta- tions in autonomic nervous-mediated syncope in children. Methods A total of 108 cases treated in our hospital be- cause of autonomic nervous-mediated syncope or psychogenic pseudosyncope from Jan. 2009 to Mar. 2012 were recruit- ed. The incidences of gastrointestinal symptoms such as abdominal pain, nausea and vomiting before the onset of syncope attack and during upright tilt test processes were analyzed in children with autonomic nervous system-mediated syncope and psychogenic pseudosyneope. Results Forty-nine boys （45.4%）and 59 girls （54.6%）were included. A total of 33 patients （35.5%）with autonomic nervous system-mediated syncope complained of gastrointestinal discomfort before attack. Fifteen （ 16.1% ） patients presented with abdominal pain, 20 （21.5% ） cases complained of nausea, and 12 （ 12.9% ） cases complained of vomiting. Twenty-seven （40.9%）cases were induced gastrointestinal discomfort in process of upright tilt test, 6 （9.1% ） cases complained of abdominal pain, 24 （ 36.4% ） cases showed nausea, but nobody was induced vomit- ing. A total of 39（59.1%） cases before the onset of attack or in the process of upright tilt test complained of gastrointesti- nal manifestations. Gastrointestinal discomfort induced by upright tilt test in postural orthostatic tachycardia syndrome children and vasovagal syncope children were up to 40% and 41.5%, respectively. However, nobody in psychogenic pseudosyncope group was induced gastrointestional discomfort during upright tilt test. The total gastrointestinal discom- fort before attack and during upright tilt test in postural orthostatic tachycardia syndrome and vasovagal syncope children were 60% and 58.5%, respectively, significantly higher than that of psychogenic pseudosyncope children in the incidence （10%） （P 〈 0.05）. Conclusion The performance of the digestive tract is one of the common symptoms of autonomic nerve-mediated syncope. The possibility of the autonomic nervous system mediated syncope should be considered in children with significant gastrointestinal discomfort cases before syncope attack or during HU upright tilt test Severe abdominal pain may be one of the most important symptoms of autonomic nerve-mediated syncope.
出处
《中国实用儿科杂志》
CSCD
北大核心
2013年第1期43-47,共5页
Chinese Journal of Practical Pediatrics
基金
国家十二五支撑计划(2012BAI03B03)
北京市科技计划项目(D10100050010059)
关键词
晕厥
体位性心动过速
血管迷走性晕厥
消化道症状
syncope
postural orthostatic tachycardia
vasovagal syncope
gastrointestional discomfort
