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目的探讨直立倾斜试验(head-up tilt test,HUTT)同时描记动态脑电图(ambulatory electroencephalogram,AEEG)在小儿晕厥鉴别诊断中的意义。方法选择2008年1月至2015年12月在本院儿科行HUTT的直立晕厥病例151例,去除成人和资料不全的9例,共142例有过直立晕厥或晕厥先兆病史者为观察对象,在完成了(动态)心电图、心脏超声、脑电图、脑血流图、脑磁共振血管成像或脑CT检查无明显异常后,描记AEEG的同时行HUTT或舌下含服硝酸甘油诱发HUTT。结果 142例患儿,平均年龄10岁,50例进行了诱发试验。97例行AEEG,其中82例与HUTT同步描记,15例在HUTT之前描记。11例AEEG正常,4例在晕厥同时出现慢波(2例为血管抑制型,2例为混合抑制型),6例非晕厥时段出现棘慢波,1例非晕厥时段出现睡眠障碍波。HUTT共81例阳性:血管抑制型32例,混合型23例,未定型13例,心脏抑制型5例,体位性心动过速5例;直立性低血压3例,1例心理性假性晕厥归到阴性中。磁共振血管造影提示6例患副鼻窦炎,其中2例为血管抑制型,2例为混合抑制型,1例为儿童体位性心动过速综合征和1例未定型。结论血管迷走性晕厥占儿童晕厥比例最大,其中血管抑制型最多;血压降低持续时间长短似乎对脑血流供应影响更大;副鼻窦炎可能会诱发血管迷走性晕厥;HUTT同时描记动态脑电图对晕厥的鉴别诊断很重要。
Objective To investigate the significance of the simultaneous detection of dynamic head-up tilt test (HUTT) and ambulatory electroencephalogram (AEEG) in the differential diagnosis of children with syncope. Methods From January 2008 to December 2015 in our hospital pediatric HUTT 151 cases of erectile dysfunction, removal of adult and incomplete data in 9 cases, a total of 142 cases had erected syncope or syncope before the history of a history of observation, in the After completing (dynamic) electrocardiogram, echocardiography, EEG, cerebral blood flow, cerebral magnetic resonance angiography or brain CT examination, there was no obvious abnormality. HUTT or sublingual nitroglycerin-induced HUTT was recorded simultaneously with AEEG. Results 142 cases of children, the average age of 10 years old, 50 cases were induced test. Ninety-seven patients underwent AEEG, of which 82 were synchronous with HUTT and 15 were marked prior to HUTT. 11 cases had normal AEEG, 4 cases showed syncope at the same time with slow wave (2 cases with vasoconstrictor and 2 cases with mixed inhibition). Six non-syncope time spikes and one non-syncope time sleep disturbance wave. HUTT was positive in 81 cases: 32 cases of vascular suppression, 23 cases of mixed type, 13 cases of unconfined type, 5 cases of cardiac inhibition and 5 cases of orthostatic tachycardia. There were 3 cases of orthostatic hypotension and 1 case of psychological pseudo- syncope Into the negative. Magnetic resonance angiography showed that 6 patients had paranasal sinusitis, of which 2 were vasoconstrictor type, 2 were mixed suppressor type, 1 was pediatric orthonic tachycardia syndrome, and 1 was not stereotyped. Conclusions Vasovagal syncope accounts for the largest proportion of children with syncope, with the most vasoconstrictors; duration of blood pressure seems to have a greater impact on cerebral blood flow; sinusitis may induce vasovagal syncope; HUTT simultaneously describes dynamic EEG The differential diagnosis of syncope is very important.