以神经系统症状起病的儿童血管迷走性晕厥或体位性心动过速综合征88例临床分析

目的 探讨以神经系统症状起病的儿童血管迷走性晕厥（VVS）及体位性心动过速综合征（POTS）的临床特点，为该类疾病早期识别提供依据。方法 回顾性分析88例以一过性意识丧失、头晕、头痛及抽搐等神经系统症状为首发症状，最终确诊为VVS或POTS的患儿的临床资料。结果 88例患儿中，男性35例（40%），女性53例（60%），年龄4~15岁，发病高峰年龄10~13岁。88例患儿皆以一过性意识丧失、头晕、头痛及抽搐为首发症状，经脑电图、脑脊液及头颅磁共振等检查，排除了神经系统疾病，经直立倾斜试验（HUTT）最终确诊为VVS 53例（60%），POTS 35例（40%）。有5例以一过性意识丧失为首发症状的患儿被误诊为癫痫。59例（67%）患儿发病前可追溯到诱因，常见诱因依次为长时间站立、体位变化及剧烈运动。66例（75%）有发作先兆症状，常见的先兆症状依次为胸闷、消化道症状（恶心、呕吐及腹痛）及面色苍白。88例患儿均接受了健康教育、自主神经功能锻炼，53例VVS患儿予口服补液盐治疗，35例POTS患儿予口服补液盐联合美托洛尔治疗。对88例患儿进行为期18个月的随访，随访3、6、12、18个月时的治疗有效率分别为87%、93%、93%、90%。结论 以一过性意识丧失、头晕、头痛及抽搐为首发症状的患儿除了考虑神经系统疾病外，需警惕VVS及POTS等功能性心血管疾病，进一步HUTT检查可明确诊断；明确诊断后早期治疗可取得较好的疗效。

Vasovagal syncope or postural orthostatic tachycardia syndrome in children with neurological symptoms at disease onset: a clinical analysis of 88 cases

Objective To study the clinical features of vasovagal syncope (VVS) and postural orthostatic tachycardia syndrome (POTS) in children with neurological symptoms at disease onset. Methods A retrospective analysis was performed on the medical data of 88 children with the initial symptoms of the nervous system, such as transient loss of consciousness, dizziness, headache, and convulsion, who were finally diagnosed with VVS or POTS. Results Of the 88 children, there were 35 boys (40%) and 53 girls (60%), with an age of 4-15 years. The peak age of onset was between 10 and 13 years. All the children had the initial symptoms of transient loss of consciousness, dizziness, headache, and convulsion. Nervous system diseases were excluded by electroencephalography, cerebrospinal fluid examination, and cranial MRI. Of the 88 children, 53 (60%) were confirmed with VVS, and 35 (40%) with POTS, according to the results of head-up tilt test (HUTT). Five children with the initial symptom of transient loss of consciousness were misdiagnosed with epilepsy. Predisposing factors were determined for 59 children (67%), and prolonged standing was the most common factor, followed by change in body position and strenuous exercise. Premonitory symptoms were observed in 66 children (75%), among which chest discomfort was the most common symptom, followed by gastrointestinal symptoms (nausea, vomiting, and abdominal pain) and pale complexion. All 88 children received health education and exercise for autonomic nerve function, among whom 53 children with VVS were given oral rehydration salts and 35 children with POTS were given oral rehydration salts and metoprolol. All 88 children were followed up for 18 months, and the response rates to the above treatment at 3, 6, 12, and 18 months of follow-up were 87%, 93%, 93%, and 90% respectively. Conclusions In addition to nervous system diseases, functional cardiovascular diseases including VVS and POTS should be considered for children with the initial symptoms of transient loss of consciousness, dizziness, headache, and convulsion. HUTT can be used to make a confirmed diagnosis, and the early treatment can achieve a good outcome.