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目的研究血管迷走性晕厥(VVS)儿童的心率变异性(HRV),探讨不同反应类型对VVS儿童HRV的影响。方法2003-01—2007-05在中南大学湘雅二医院晕厥专科诊治的不明原因晕厥(UPS)或接近晕厥儿童87例(晕厥组),其中男34例,女53例;年龄4～17(10.92±2.62)岁。匹配73例健康儿童为对照(对照组)。晕厥组与对照组儿童均行24h动态心电图(Holter)检查,将所记录数据输入TLC 3000A12通道动态心电图分析系统,程序自动分析结合人工干预生成HRV时域指标和频域指标。晕厥组儿童在Holter检查前后1d内行直立倾斜试验(HUTT)检查。用SPSS11.0软件进行数据统计分析。结果(1)晕厥组儿童HUTT阳性率62.1%(54/87);HUTT阳性儿童中男31.5%(17/54),女68.5%(37/54);血管抑制型38例(70.4%),混合型14例(25.9%),心脏抑制型2例(3.7%)。(2)与对照组比较,晕厥组儿童时域指标和频域指标均降低,其中SDNN、VLF(P<0.05)和TP、LF、HF(P<0.01)降低显著。(3)与对照组比较,HUTT阳性组儿童时域指标SDANN降低明显(P<0.05),其余时域指标和频域指标稍降低(P>0.05)。(4)血管抑制型与混合型儿童相比,各项时域指标均降低,以SDNN降低明显(P<0.05);频域指标TP、VLF、LF、HF稍降低(P>0.05)。结论VVS儿童基础自主神经功能异常,血管抑制型是最常见的反应类型,VVS儿童的HRV与反应类型有关。
Objective To study the heart rate variability (HRV) in children with vasovagal syncope (VVS) and to explore the effect of different response types on HRV in children with VVS. Methods From January 2003 to July 2007, 87 patients (syncope group) with faint syncope (UPS) or syncope were diagnosed and treated in the Second Xiangya Hospital of Central South University. There were 34 males and 53 females, aged 4 to 17 10.92 ± 2.62) years old. Matched 73 healthy children as a control (control group). The syncope group and the control group were subjected to 24-hour Holter examination. The recorded data were input into the TLC 3000A12 channel electrocardiogram analysis system. The program automatically analyzed the time-domain index and the frequency domain index of HRV generated by human intervention. Children in the syncope group underwent orthostatic tilt test (HUTT) 1 d before and after Holter examination. Using SPSS11.0 software for statistical analysis of data. Results (1) The positive rate of HUTT in children with syncope was 62.1% (54/87). The positive rate of HUTT in children with HUTT was 31.5% (17/54) and 68.5% (37/54) respectively. The number of vasoconstrictor was 38.4% Mixed 14 cases (25.9%), cardiac inhibition in 2 cases (3.7%). (2) Compared with the control group, the time domain index and the frequency domain index of the syncope group were all decreased, among which SDNN and VLF (P <0.05) and TP, LF and HF (P <0.01) decreased significantly. (3) Compared with the control group, SDANN decreased significantly in HUTT positive group (P <0.05), while the other time domain indexes and frequency domain indexes decreased slightly (P> 0.05). (4) Compared with the mixed children, the vasoconstrictor decreased in each time domain and decreased significantly with SDNN (P <0.05). The frequency domain indexes TP, VLF, LF and HF decreased slightly (P> 0.05). Conclusions The autonomic nerve dysfunction in children with VVS is the most common type of vascular response. The HRV in children with VVS is related to the type of response.