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口服补液盐和盐酸米多君对儿童血管迷走性晕厥的干预研究
The Efficacy of Oresol and Midodrine Hydrochloride in the Treatment of Children with Vasovagal Syncope
【作者】 刘晓燕；
【导师】 王成；
【作者基本信息】 中南大学 ， 儿科学， 2009， 硕士
【摘要】 目的追踪观察口服补液盐及盐酸米多君干预前、后晕厥及先兆晕厥症状、直立倾斜试验(HUTT)结果及血流动力学变化,探讨口服补液盐及盐酸米多君对儿童血管迷走性晕厥(VVS)的治疗效果。方法2007-11～2008-10在中南大学湘雅二医院儿童晕厥专科就诊或住院的6～17岁(平均11.21±3.13岁)48例不明原因晕厥(UPS)或晕厥先兆、HUTT阳性的VVS儿童,分健康教育组(n=10)、口服补液盐组(n=23)、盐酸米多君组(n=15)三组,根据HUTT结果评价疗效。治疗6个月后,如没有晕厥或晕厥先兆发作则停药并继续随访,评价患儿晕厥及晕厥先兆复发率、药物不良反应及干预前后血流动力学变化,用统计软件SPSS 11.5进行数据统计分析。结果①HUTT转阴率在健康教育组、口服补液盐组及盐酸米多君组分别为20.0%(2/10)、60.9%(14/23)及80.0%(12/15),其中盐酸米多君组及口服补液盐组明显高于健康教育组(P均＜0.05),盐酸米多君组及口服补液盐组差异无统计学意义(P＞0.05)。②随访6～12个月,晕厥及晕厥先兆复发率在健康教育组、口服补液盐组、盐酸米多君组分别为60%(6/10)、52.2%(12/23)及13.3%(2/15),盐酸米多君组明显低于前两组(P＜0.05),健康教育组和口服补液盐组差异无统计学意义(P＞0.05)。③三组在干预前后平卧位血压和心率差异无统计学意义(P＞0.05);盐酸米多君组干预后倾斜起始与基础平卧位心率及血压差值显著缩小(P＜0.05)。结论①盐酸米多君和口服补液盐对VVS儿童的干预效果明显优于单纯健康教育治疗。②健康教育和口服补液盐治疗一定程度上可预防VVS儿童晕厥发作,但盐酸米多君治疗可明显减少VVS患者晕厥复发。③盐酸米多君不改变VVS儿童基础平卧位心率和血压,无特殊不良反应。④盐酸米多君可减少体位改变时血流动力学的变化,改善直立不耐受症状。以上提示健康教育和口服补液盐是治疗VVS儿童的基本措施,辅以盐酸米多君治疗能加强其干预效果,并能安全有效地应用于反复晕厥发作的VVS儿童。
【Abstract】 Objiective To explore the efficacy of midodrine hydrochloride and oresol on the treatment of vasovagal syncope(VVS) in children.Methods Forty-eight children with unexplained syncope and prodromata(21male,27female,aged6-17yrs,mean 11.21±3.13yrs) were randomly assigned into 3 groups.They were health education group, oresol group and midodrine hydrochloride group,respectively.Oresol group comprised children given oresol as first-line therapy in addition to health education,and midodrine hydrochloride group comprised patients given midodrine hydrochloride on base of oresol group.Repeat head-up tilt testing(HUTT) and follow-up of least 6 months were conducted to evaluate the therapeutic effectiveness,side effects of midodrine and the change of haemodynamics in treating VVS in children.Results①The HUTT-based effective rate of 3 group was respectively 20%(2/10),60.9%(14/23)and 80%(12/15).It was significantly higher in cases of midodrine hydrochloride group and oresol group than that of health education group(P＜0.05).However,there was no significant difference in the HUTT-based effective rate between oresol group and midodrine hydrochloride group(P＞0.05).②During the follow-up period, the recurrence rate of syncope was significantly lower in midodrine hydrochloride group than in other two groups(P＜0.05).However,there was no significant difference in the recurrence rate of syncope between health education and oresol groop(P＞0.05).③There was no statistic difference in hemodynamics index(HR,SBP,DBP) on supine between before and after treatment in 3 groups.After midodrine hydrochloride therapy,the effects of midodrine hydrochloride on changes in systolic and diastolic pressures and heart rate,between upright begining and supine positions,were statistically significant(P＜0.05).Conclusion①The efficacy of midodrine hydrochloride and oresol on the treatment VVS is superior to simple health education.②To some extent,health education and oresol can prevent syncope attack of patients with VVS,but midodrine hydrochloride treatment can significantly reduce the recurrence of syncope in patients with VVS.③Midodrine hydrochloride do not change the basic heart rate and blood pressure in supine position,no special side effects.④Midodrine can stable hemodynamic changes with body position changes.Health education and oresol are conventional therapies for VVS in children.The efficacy can be enhanced by supplement midodrine hydrochlorate, furthermore,which is effective and safe in treating VVS in children.