进一步关注儿童青少年神经介导性晕厥的诊治及预防

doi:10.11852/zgetbjzz2020-0295

摘要/Abstract

摘要： 神经介导性晕厥是指由于大脑一过性缺血缺氧所致的短暂性意识丧失,多伴有肌张力丧失而不能维持自主体位,是儿科门诊中的常见急症。约有15%的儿童及青少年18岁前至少发生过1次晕厥, 晕厥患儿占所有儿科急诊的1%。近三十年来随着直立倾斜试验及晕厥诊断程序的提出,不明原因晕厥患儿的比例逐渐下降,但仍有14%左右的晕厥儿童病因未知,且晕厥发病机制仍需进一步探索。本文结合近年来相关领域新进展,介绍儿童青少年神经介导性晕厥的流行病学特点、发病机制、诊断程序及未来研究方向,以期提高临床医师对儿童青少年神经介导性晕厥的认识,进一步提高我国儿童晕厥的诊治水平。

关键词: 神经介导性晕厥, 儿童, 青少年

Abstract: Neurally mediated syncope is a transient loss of consciousness caused by transient ischemic hypoxia in the brain, which was often accompanied by loss of muscle tone and cannot maintain the posture.It is a common emergency in pediatric clinics.About 15% of children and adolescents have had at least once syncope before 18 years old, and syncope accounts for 1% of all pediatric emergencies.With the introduction of head-up tilt test and diagnostic protocol of syncope in the past 30 years, the proportion of children with unexplained syncope has gradually decreased, but still around 14% children or adolescents with syncope could not be explained, and the pathogenesis of syncope still needs to be further explored.Based on the recent developments in related fields in recent years, this review introduces the epidemiological characteristics, pathogenesis, diagnostic procedures and future research directions of children′s neuro-mediated syncope, with a view to improving clinicians′ understanding of children′s neuro-mediated syncope and further improving diagnosis and treatment of syncope in China.

Key words: neurally mediated syncope, children, adolescents

中图分类号:

R725

马乐, 蔺婧. 进一步关注儿童青少年神经介导性晕厥的诊治及预防[J]. 中国儿童保健杂志, 2020, 28(4): 361-365.

MA Le, LIN Jing. Further attention to the diagnosis, treatment and the prevention of children and adolescents with neurally mediated syncope[J]. journal1, 2020, 28(4): 361-365.

参考文献

[1] 杜军保,李万镇,陈建军.基础直立倾斜试验对儿童不明原因晕厥的诊断研究[J].中华儿科杂志,1997,35(6):30-33.
[2] 张清友,杜军保,李万镇.舌下含化硝酸甘油直立倾斜试验对儿童不明原因晕厥的诊断研究[J].中华儿科杂志,2004,42(5):371-374.
[3] 杨园园,陈建军,洪黛玲,等.儿童血管迷走性晕厥诊断程序的卫生经济学评价[J].中国实用儿科杂志,2006,21(2):96-98.
[4] European Heart Rhythm Association( EHRA), Heart Failure As-sociation(HFA), Heart Rhythm Society( HRS), et al.Guidelines for the diagnosis and management of syncope (version 2009) : the task force for the diagnosis and management of syncope of the European Society of Cardiology ( ESC) [J].Eur Heart J,2009,30(21):2631-2671.
[5] 蔺婧,王瑜丽,张清友,等.儿童青少年晕厥疾病谱近30年变化及卫生经济学分析单中心报告[J].中国实用儿科杂志,2016,31(5):350-355.
[6] Driscoll DJ, Jacobsen SJ, Porter CJ, et al.Syncope in children and adolescents [J].J Am Coll Cardiol, 1997,29(5):1039-1045.
[7] Mosqueda-Garcia R, Furlan R, Tank J, et al.The elusive pathophysiology of neurally mediated syncope [J].Circulation, 2000, 102(23): 2898-2906.
[8] 胡尔林,王成,贺宇轩,等.长沙市中小学生不明原因晕厥发病率及其影响因素分析[J].中华实用儿科临床杂志,2014,29(13):979-982.
[9] Lin J, Han Z, Li X, et al.Risk factors for postural tachycardia syndrome in children and adolescents [J].PLoS One,2014, 9(12):e113625.
[10] Chen L, Wang C, Wang H, et al.Underlying diseases in syncope of children in China [J].Med Sci Monit,2011,17(6):PH49-PH53.
[11] 金红芳,张凤文,王成,等.儿童一过性意识丧失的基础疾病分析[J].中国小儿急救医学,2012,19(4):360-363.
[12] 张清友,杜军保,李源,等.血管迷走性晕厥儿童血管内皮功能的彩色多普勒超声检测[J].中国实用儿科杂志,2005,20(8):482-484.
[13] Zhang F, Li X, Stella C, et al.Plasma hydrogen sulfide in differential diagnosis between vasovagal syncope and postural orthostatic tachycardia syndrome in children [J].J Pediatr,2012,160(2):227-231.
[14] Zhang F, Li X, Ochs T, et al.Midregional pro-adrenomedullin as a predictor for therapeutic response to midodrine hydrochloride in children with postural orthostatic tachycardia syndrome [J].J Am Coll Cardiol,2012,60(4):315-320.
[15] Zhao J, Tang C, Jin H, et al.Plasma copeptin and therapeutic effectiveness of midodrine hydrochloride on postural tachycardia syndrome in children [J].J Pediatr, 2014,165(2):290-294.
[16] Lin J, Han Z, Li H, et al.Plasma C-type natriuretic peptide as a predictor for therapeutic response to metoprolol in children with postural tachycardia syndrome[J].PLoS One ,2015,10(3):e0121913.
[17] Zhang Q, Liao Y, Tang C, et al.Twenty-four-hour urinary sodium excretion and postural orthostatic tachycardia syndrome [J].J Pediatr,2012,161(2):281-284.
[18] Zhang Q, Chen X, Li J, et al.Orthostatic plasma norepinephrine level as a predictor for therapeutic response to metoprolol in children with postural tachycardia syndrome [J].J Transl Med,2014,12: 249.
[19] Li Y, He B, Li H, et al.Plasma Homocysteine level in children with postural tachycardia syndrome[J].Front Pediatr,2018,6:375.
[20] Bai W, Han Z, Chen S, et al.Serum resistin negatively correlates with clinical severity of postural tachycardia syndrome in children[J].Pediatric Cardiology, 2017,38(8),1639-1644.
[21] Lu W, Yan H, Wu S, et al.Electrocardiography-derived predictors for therapeutic response to treatment in children with postural tachycardia syndrome[J].J Pediatr, 2016,176:128-133.
[22] Wang Y, Zhang C, Chen S, et al.Heart rate variability predicts therapeutic response to metoprolol in children with postural tachycardia syndrome[J].Front Neurosci,2019,13:1214.
[23] Li H, Liao Y, Wang Y, et al.Baroreflex sensitivity predicts short-term outcome of postural tachycardia syndrome in children[J].PLoS One,2016,11(12): e0167525.
[24] Tao C, Li X, Tang C, et al.Acceleration index predicts efficacy of orthostatic training on vasovagal syncope in children[J].J Pediatr, 2018,207, 54-58.
[25] Benditt DG, Ad Hoc Syncope Consortium.The ACCF/AHA scientific statement on syncope: a document in need of thoughtful revision [J].Europace,2006, 8(12):1017-1021.
[26] Brignole M, Alboni P, Benditt DG et al.Guidelines on management (diagnosis and treatment) of syncope-update 2004.[J].Europace, 2004, 6(6):467-537.
[27] Zhang Q, Du J, Wang C, et al.The diagnostic protocol in children and adolescents with syncope: a multi-centre prospective study [J].Acta Paediatr,2009,98(5):879-884.
[28] 陈丽,杜军保,张清友,等.β受体阻滞剂治疗儿童自主神经介导性晕厥的多中心研究[J].中华儿科杂志,2007,45(12):885-888.
[29] Zhang Q, Du J, Tang C.The efficacy of midodrine hydrochloride in the treatment of children with vasovagal syncope[J].J Pediatr,2006,149(6):777-780.
[30] Chen L, Wang L, Sun J, et al.Midodrine hydrochloride is effective in treatment of children with postural orthostatic tachycardia syndrome[J].Circ J,2011,75(4):927-931.
[31] 张凤文,廖莹,李雪迎,等.血管舒张反应预测盐酸米多君治疗儿童血管迷走性晕厥疗效价值研究[J].中国实用儿科杂志,2012,27(2):102-105.
[32] Deng W, Liu Y, Liu AD, et al.Difference between supine and upright blood pressure associates to the efficacy of midodrine on postural orthostatic tachycardia syndrome (POTS) in children [J].Pediatr Cardiol, 2014, 35(4): 719-725.