儿童不明原因心悸与直立倾斜试验的关系

摘要

Objective:To explore the relationship between unexplained palpitation in children and head-up tilt test (HUTT).Methods:A total of 142 children with the main symptom of unexplained palpitation were admitted to the Specialist Out-Patient Clinic of Children's Cardiovascular Disease from Sept.2008 to Feb.2017 in the Second Xiangya Hospital,Central South University.Among them,63 cases were male,79 cases were female,with the mean age of (10.12±2.88) years old.The detailed history,physical examinations,conventional 12 electrocardiogram,chest X-ray,echocardiography,myocardial enzymes and thyroid function were all examined.The disorders of heart disease,systemic disease and drug effect were ruled out.The HUTT inspection was then given to them.Results:Among the 142 palpitation cases,79 cases were HUTT positive (55.6％) and 63 cases were HUTT negative (44.4％).The age in HUTT positive patients was older than that in HUTT negative patients (P＜0.05),with no significant difference in gender (P＞0.05).There were three types of hemodynamic changes in HUTT positive patients.Among them,38 cases were postural orthostatic tachycardia syndrome (48.1％),36 cases were the vasovagal syncope vasodepressive type (45.6％) and 5 cases were the vasovagal syncope mixed type (6.3％).There were no hemodynamic types for vasovagal syncope cardioinhibitory type,orthostatic hypotension and orthostatic hypertension.Conclusion:Among the clinically unexplained palpitations children,more than half are caused by unbalanced autonomic nervous function.HUTT can help clear the cause of unexplained palpitations.%目的:探讨儿童不明原因心悸与直立倾斜试验(head-up tilt test,HUTT)的关系.方法:选择2008年9月至2017年2月在中南大学湘雅二医院儿童心血管专科门诊就诊或住院的不明原因心悸患儿142例,年龄3～18(10.12±2.88)岁,其中男63例,女79例.经询问详细病史、体格检查、常规心电图、动态心电图、胸部X线片、超声心动图、心肌酶、甲状腺功能等检查排除心脏疾病、系统性疾病及药物影响等.所有患儿行HUTT检查.结果:142例心悸患儿中HUTT阳性79例(55.6％),阴性63例(44.4％).HUTT阳性组年龄为5～16(10.72±2.59)岁,高于HUTT阴性组的3～18(9.37±3.07)岁(t=2.843,P＜0.05).HUTT阳性组男女人数之比为33:46,HUTT阴性组男女人数之比为30:33,两组比较差异无统计学意义(x2=0.485,P＞0.05).HUTT阳性患儿中体位性心动过速综合征38例(48.1％),血管迷走性晕厥血管抑制型36例(45.6％),血管迷走性晕厥混合型5例(6.3％),未见血管迷走性晕厥心脏抑制型、直立性低血压、直立性高血压等类型.结论:临床上不明原因心悸儿童,超过半数是由自主神经功能失衡引起,及时进行HUTT能为明确病因提供帮助.