直立倾斜试验同步描记动态脑电图对儿童晕厥诊断的意义

摘要

目的：探讨直立倾斜试验（head-up tilt test，HUTT）同时描记动态脑电图（ambulatory electroencephalogram，AEEG）在小儿晕厥鉴别诊断中的意义。方法选择2008年1月至2015年12月在本院儿科行HUTT的直立晕厥病例151例，去除成人和资料不全的9例，共142例有过直立晕厥或晕厥先兆病史者为观察对象，在完成了（动态）心电图、心脏超声、脑电图、脑血流图、脑磁共振血管成像或脑CT检查无明显异常后，描记AEEG的同时行HUTT或舌下含服硝酸甘油诱发HUTT。结果142例患儿，平均年龄10岁，50例进行了诱发试验。97例行AEEG，其中82例与HUTT同步描记，15例在HUTT之前描记。11例AEEG正常，4例在晕厥同时出现慢波（2例为血管抑制型，2例为混合抑制型），6例非晕厥时段出现棘慢波，1例非晕厥时段出现睡眠障碍波。HUTT共81例阳性：血管抑制型32例，混合型23例，未定型13例，心脏抑制型5例，体位性心动过速5例；直立性低血压3例，1例心理性假性晕厥归到阴性中。磁共振血管造影提示6例患副鼻窦炎，其中2例为血管抑制型，2例为混合抑制型，1例为儿童体位性心动过速综合征和1例未定型。结论血管迷走性晕厥占儿童晕厥比例最大，其中血管抑制型最多；血压降低持续时间长短似乎对脑血流供应影响更大；副鼻窦炎可能会诱发血管迷走性晕厥；HUTT同时描记动态脑电图对晕厥的鉴别诊断很重要。%Objective To evaluate the significance of the ambulatory electroencephalogram(AEEG) in child syncope during head-up tilt test (HUTT).Method The cohort included 142 consecutive children (mean age 10 years) were assessed for syncope by routine investigations. All children performed serum biomarker test, electroencephalogram (EEG), trans cranial Doppler (TCD), head magnetic resonance angiography (MRA) or head computed tomography. During AEEG was concomitant with HUTT or HUTT and provocative test with sublingual nitroglycerin. Result In 142 cases, the mean age was 10 years old, and 50 cases were induced by the test. AEEG done in 97 patients, 82 were synchronous with HUTT, 15 before HUTT. Abnormal AEEG were found in 11 patients, 4 cases with high-voltage slow wave during syncope or pre-syncope in HUTT (2 vasodepressor syncope and 2 mixed inhibitory), 6 cases with spark wave and 1 case with sleep disorder were found during non-syncope.81 patients HUTT are positive: vasodepressor syncope 32 cases, mix inhibitory 23 cases, suspense 13 cases, cardio-inhibitory 5 cases, post orthostatic tachycardia syndrome (POTS) 5 cases, ortheocratic hypotension (OH) 3 cases; 1 case of pseudo-syncope belongs to negative. Vice sinusitis were found in 6 cases of magnetic resonance angiography, among of them, 2 vasodepressor, 2 mixed inhibitory, 1 POTS and pseudo-syncope. Conclusion Vasovagal syncope was common seen in teenage, vasodepressor syncope was more popular than others; hypotension may play more important role in cerebral hemo-dynamics; sinusitis may induce vasovagal syncope; AEEG are very important during HUTT to diagnose for children syncope.