[头高位倾斜试验期间的血流动力学变化及其对预测美托洛尔治疗小儿血管迷走性晕厥疗效的价值]
[Hemodynamic changes during head-up tilt test and predictive value thereof in predicting the efficacy of metoprolol therapy in children with vasovagal syncope].
作者信息
Zhang Qing-you, DU Jun-bao, Zhen Jing-lan, Li Wan-zhen, Wang Yu-li
机构信息
Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
出版信息
Zhonghua Yi Xue Za Zhi. 2007 May 15;87(18):1260-2.
OBJECTIVE
To investigate the value of hemodynamic changes during head-up tilt (HUT) test and predictive value thereof in evaluating the efficacy of metoprolol therapy in children with vasovagal syncope (VSS).
METHODS
Twenty-six consecutive children with history of VSS diagnosed by head-up tilt (HUT) or sublingual nitroglycerin potentiated head-up tilt (SNHUT), who were treated with metoprolol for 6 approximately 12 months and followed up for (18 +/- 9) months (12 approximately 36 months), were divided into two groups according to effect of metoprolol: effective treatment group (n = 16, aged 12 +/- 2) without VSS recurrence during treatment and fellow-up, and futile treatment group (n = 10, aged 12 +/- 3). The heart rate changes during HUT or SNHUT were evaluated between the two groups.
RESULTS
There were no significant differences between these 2 groups with regard to the demographic and clinical characteristics including age, gender, history, syncope spells, follow-up time and heart rate, mean blood pressure in supine position and during positive response. For example, the baseline heart rate of the effective treatment group was 81 +/- 12 beats/min, not significantly different from that of the futile treatment group (78 +/- 8 beats/min, P = 0.804). However, during tilt test 16 of the 26 patients in the effective treatment group showed tachycardia before positive response, with the mean heart rate of (123 +/- 15) beats/min, whereas all 10 patients in the futile group did not have tachycardia before positive response, with the mean heart rate of (96 +/- 17) beats/min. If an increase of 30 beats/min was taken as a borderline in heart rate during positive response in HUT compared with that of baseline value, in respect of predicting the metoprolol efficacy in the treatment of VVS, the sensitivity was 81% (13/16), the specificity was 80% (8/10), and the diagnostic value was 81% (21/26).
CONCLUSION
A marked increase in heart rate in HUT or SNHUT is a better predictor of metoprolol efficacy in the treatment of children with VVS.
目的
探讨直立倾斜试验（HUT）期间血流动力学变化的价值及其在评估美托洛尔治疗小儿血管迷走性晕厥（VSS）疗效中的预测价值。
方法
连续纳入26例经直立倾斜试验（HUT）或舌下含服硝酸甘油激发直立倾斜试验（SNHUT）确诊为VSS的患儿，给予美托洛尔治疗6至12个月，并随访（18±9）个月（12至36个月），根据美托洛尔治疗效果分为两组：有效治疗组（n = 16，年龄12±2岁），治疗及随访期间无VSS复发；无效治疗组（n = 10，年龄12±3岁）。评估两组在HUT或SNHUT期间的心率变化。
结果
两组在人口统计学和临床特征方面无显著差异，包括年龄、性别、病史、晕厥发作次数、随访时间以及心率、平卧位平均血压和阳性反应时的平均血压。例如，有效治疗组的基线心率为81±12次/分钟，与无效治疗组（78±8次/分钟，P = 0.804）无显著差异。然而，在倾斜试验中，有效治疗组26例患者中有16例在阳性反应前出现心动过速，平均心率为（123±15）次/分钟，而无效治疗组的10例患者在阳性反应前均未出现心动过速，平均心率为（96±17）次/分钟。若将HUT阳性反应时心率较基线值增加30次/分钟作为临界值，在预测美托洛尔治疗VVS的疗效方面，敏感性为81%（13/16），特异性为80%（8/10），诊断价值为81%（21/26）。
结论
HUT或SNHUT期间心率显著增加是美托洛尔治疗小儿VVS疗效的较好预测指标。
Zotero 插件