摘要:
Objective To evaluate the predictive value of changes in postural blood pressure of medodrine hydrochloride in treatment of children's postural tachycardia syndrome (POTS). Methods By using prospective study method, a total of 80 cases diagnosed as POTS in this hospital during October 2009 to October 2014 were allocated as study subjects, all these patients were treated with medodrine hydrochloride for 3 months,according to changes in blood pressure of children with vertical experiment grouping, children with blood pressure at upright position lower than that of recumbent, constant or increasing at 6.5 mmHg or less were listed into observation group (n = 52), and children with increase of blood pressure from recumbent to upright >6.5 mm Hg were listed in control group (n = 28). In comparison with these two groups of children by symptom scores before and after treatment,hemodynamic parameters of children in 3 to 8 years follow- up period, the proportion of children with asymptomatic double variables by using Pearson correlation analysis on changes in upright blood pressure, and proportion of children without symptom at the end of follow- up period. Results The difference in systolic and diastolic blood pressure of these two groups was statistically significant(P <0.05), but the change in heart rate was not statistically significant (P >0.05). There was no statistically significant difference between these two groups before treatment (P <0.05), and the difference in symptom scores was statistically significant (P <0.05). The proportion of children without symptom at the end of follow- up period was significantly lower than that of control group (P <0.05). According to Pearson bivariate correlation analysis,the ratio of asymptomatic children and changes in upright blood pressure were positively correlated (r =7.225, P <0.05). Conclusion The prediction value of long term effect on changes in postaxial blood pressure treated by medoddrine hydrochloride is high, hence it may be used for treatment of children with POTS, and it can be used as a useful reference for the individualized treatment of children with POTS.%目的 评价直立后血压变化对盐酸米多君治疗儿童体位性心动过速综合征(POTS)远期疗效的预测价值.方法 采用前瞻性研究方法,选择2009年10月至2014年10月期间西安市第三医院收治的80例确诊为POTS患儿作为研究对象,所有患者均接受盐酸米多君治疗3个月,根据患儿直立实验过程中血压变化情况进行分组,直立后的血压较平卧时降低、不变以及增加≦6.5 mmHg者纳入观察组(n=52),直立后的血压较较平卧时增加>6.5 mmHg者纳入对照组(n=28),比较两组患儿治疗后的血流动力学指标以及治疗前后的症状评分,对患儿进行3~8年的随访,比较两组患儿随访终点时无症状患儿的比率,采用Pearson双变量相关分析直立后血压变化与随访终点时无症状患儿的比率的相关性.结果 两纽患儿治疗后的平卧位与站立位的收缩压、舒张压变化差异有统计学意义(P<0.05),但心率变化无统计学意义(P>0.05);两组患儿治疗前的症状评分差异无统计学意义(P>0.05),治疗后两的症状评分均下降,且观察组明显低于对照组,差异有统计学意义(P<0.05);观察组患儿随访终点时无症状患儿的比率(61.5%)明显低于对照组(81.2%),差异有显著性(P<0.05);经Pearson双变量相关分析,直立后血压变化与随访终点时无症状患儿的比率呈显著正相关(=7.225,P<0.05).结论 直立后血压变化对盐酸米多君治疗儿童POTS远期疗效的预测价值较高,可以将其作为POTS患儿个体化治疗的有益参考.