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目的研究脑电图、24h动态心电图和直立试验在以晕厥为首发症状患儿诊断方面的意义。方法回顾性分析2007年7月~2013年3月在深圳市儿童医院就诊的以晕厥为首发症状140例患儿的临床资料。所有患儿均进行脑电图检查、24h动态心电图检查和直立试验。结果所有患儿中7例患儿脑电图结果显著异常,试验均为阴性,随访后诊断为癫痫,占5.0%;32例患儿脑电图结果为界限,占22.9%,随访过程中脑电图无显著变化,其中6例直立试验为阳性;101例患儿脑电图结果正常,占72.1%,其中22例直立试验阳性。140例晕厥患儿直立试验出现阳性结果的为28例,占20.0%。所有患儿24h动态心电图结果发现2例阵发性室性心动过速,占1.4%,未发现窦性停搏及高度房室传导阻滞患儿;此2例阵发性室性心动过速患儿未发现脑电图异常且直立试验阴性。在140例晕厥病例中未出现脑电图异常且直立试验阳性的患儿。结论以晕厥为首发症状的患儿进行脑电图、24h动态心电图和直立试验联合检查对初步筛选诊断有重要意义。
Objective To study the significance of EEG, 24h ambulatory electrocardiogram and upright test in the diagnosis of children with syncope as the first symptom. Methods The clinical data of 140 children with syncope as the first symptom were retrospectively analyzed from July 2007 to March 2013 in Shenzhen Children’s Hospital. All children underwent EEG examination, 24h Holter examination and upright test. Results Seven of the children had abnormal EEG results. All the tests were negative and were diagnosed as epilepsy after follow-up, accounting for 5.0%. Out of 32 children, the result of EEG was 22.9% No significant changes in the electrogram, of which 6 were positive for upright test; 101 patients with normal EEG results, accounting for 72.1%, of which 22 were positive upright test. Forty-eight cases (20.0%) were positive in upright test in 140 children with syncope. All patients 24h dynamic electrocardiogram found in 2 cases of paroxysmal ventricular tachycardia, accounting for 1.4%, found no sinus arrest and a high degree of atrioventricular block in children; the two cases of paroxysmal ventricular tachycardia EEG was not found in children with abnormal and upright test negative. In 140 cases of syncope did not appear EEG abnormalities and upright test positive children. Conclusion EEG was the first symptom of syncope in children. The combination of 24 hours electrocardiogram and upright test was important for the preliminary screening diagnosis.