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目的探讨鉴别血管迷走性晕厥(VVS)及体位性心动过速综合征(POTS)的临床依据。方法 2009年4月至2011年4月于北京大学第一医院儿科门诊就诊并确诊为VVS的儿童40例,年龄6～18岁,平均(11.8±2.9)岁;POTS儿童165例,年龄5～19岁,平均(11.4±2.7)岁。评价与检查手段包括临床表现、家族史、生活习惯、直立试验以及直立倾斜试验。结果 VVS和POTS在儿童时期的共同特征包括学龄期及青春期多发、女孩稍多于男孩、发作季节以夏秋季多见、多数患儿有诱因和发作先兆、发作后仍有不适、平卧后症状可缓解。在VVS儿童中以晕厥为主要表现者明显多于POTS(P<0.001),在POTS儿童中,以头晕为表现的患儿明显多于VVS(P<0.001)。VVS患儿中父方有直立不耐受家族史者明显多于POTS患儿(P<0.05)。结论直立倾斜试验是鉴别VVS与POTS的重要客观检查手段。晕厥及头晕的发生频率对于临床鉴别诊断VVS与POTS具有参考价值。
Objective To explore the clinical basis for differentiating vasovagal syncope (VVS) and orthostatic tachycardia syndrome (POTS). Methods From April 2009 to April 2011, 40 children were diagnosed as VVS in Peking University First Hospital, aged from 6 to 18 years, with an average of (11.8 ± 2.9) years; 165 POTS children aged 5 ~ 19 years old, mean (11.4 ± 2.7) years old. Evaluation and examination tools include clinical manifestations, family history, lifestyle, upright test and upright tilt test. Results The common features of VVS and POTS in childhood included multiple school-age and adolescent girls, slightly more girls than boys, more common seasons in summer and fall, most of them had predisposing factors and seizures, discomfort after the onset of symptoms, post-supine symptoms Can be alleviated. Significantly more syncope was observed in children with VVS than in POTS (P <0.001). Children with POTS had significantly more dizziness than VVS (P <0.001). Among the children with VVS, there were significantly more family members who were intolerant to family history of POTS than those with POTS (P <0.05). Conclusion Upright tilt test is an important objective test to identify VVS and POTS. Syncope and dizziness frequency of occurrence for the differential diagnosis of VVS and POTS have a reference value.