Tanaka Hidetaka, Fujita Yukihiko, Takenaka Yoshito, Kajiwara Souhei, Masutani Satoshi, Ishizaki Yuko, Matsushima Reiko, Shiokawa Hirosato, Shiota Madoka, Ishitani Nobuo, Kajiura Mitsugu, Honda Kazuo
Department of Pediatrics, Osaka Medical College, Takatsuki, Osaka, Japan.
Pediatr Int. 2009 Feb;51(1):169-79. doi: 10.1111/j.1442-200X.2008.02783.x.
This clinical practice guideline provides recommendations for the assessment, diagnosis and treatment of school-aged children and juveniles with orthostatic dysregulation (OD), usually named orthostatic intolerance in USA and Europe. This guideline is intended for use by primary care clinicians working in primary care settings. The guideline contains the following recommendations for diagnosis of OD: (i) initial evaluation composed of including and excluding criteria, the assessment of no evidence of other disease including cardiac disease and so on; (ii) a new orthostatic test to determine four different subsets: instantaneous orthostatic hypotension, postural tachycardia syndrome, neurally mediated syncope and delayed orthostatic hypotension; (iii) evaluation of severity; and (iv) judgment of psychosocial background with the use of rating scales. The guideline also contains the following recommendations for treatment of OD on the basis of the result of an orthostatic test in addition to psychosocial assessment: (i) guidance and education for parents and children; (ii) non-pharmacological treatments; (iii) contact with school personnel; (iv) use of adrenoceptor stimulants and other medications; (v) strategies of psychosocial intervention; and (vi) psychotherapy. This clinical practice guideline is not intended as a sole source of guidance in the evaluation of children with OD. Rather, it is designed to assist primary care clinicians by providing a framework for decision making of diagnosis and treatments.
本临床实践指南针对患有体位性调节障碍（OD）的学龄儿童和青少年的评估、诊断及治疗提供建议，在美国和欧洲通常称为体位性不耐受。本指南供在基层医疗环境中工作的基层医疗临床医生使用。该指南包含以下关于OD诊断的建议：（i）初始评估，包括纳入和排除标准，评估无其他疾病证据，包括心脏病等；（ii）一项新的体位性测试，以确定四个不同的亚组：瞬间体位性低血压、姿势性心动过速综合征、神经介导性晕厥和延迟性体位性低血压；（iii）严重程度评估；以及（iv）使用评定量表判断心理社会背景。该指南还包含以下基于体位性测试结果及心理社会评估之外的OD治疗建议：（i）对家长和儿童的指导与教育；（ii）非药物治疗；（iii）与学校工作人员联系；（iv）使用肾上腺素能受体兴奋剂和其他药物；（v）心理社会干预策略；以及（vi）心理治疗。本临床实践指南并非作为评估OD儿童的唯一指导来源。相反，它旨在通过提供诊断和治疗决策框架来协助基层医疗临床医生。
