Analyze Of Ambulatory Blood Pressure With Vasovagal Syncope In Children And Adolescents

Objectives:To discuss the variation of parameters in ambulatory blood pressure for vasovagal syncope (VVS) in children and adolescents, and to analyze the diagnostic value of ambulatory blood pressure pattern in paediatric patients with VVS, investigate the diagnostic value of ambulatory blood pressure for VVS in children and adolescents.Methods:Sevevty-two children (32 males, forty females, mean age 10.98±1.86 years) were enrolled in this study, who came from children syncope outpatient department or inpatient department of the Second Xiangya Hospital of Central South University during Sep 2008 to Feb 2010. After confirmed diagn-osis VVS by positive head-up tilt test (HUTT), each patient wa-s taking ABPM. Forty healthy children (19 males and 21 females, mean age 10.24±2.01 years). Parameters of children with VVS in ambulatory blood pressure and diagnostic value of ambulatory blood pressure pattern were analyzed. SPSS 17.0 software was used for the statistical analysis of these data.Results:①24-hour mean systolic pressure (24hSBP),24-hour mean diastolic pressure (24hDBP), daytime mean systolic pressure (DSBP) and nighttime mean systolic pressure (NSBP) in VVS group were higher than those of the control group, reapectively (P<0.05). But there were no significant differences in daytime mean diastolic pressureand (DDBP) and nighttime mean diastolic pressure (NDBP) (P>0.05). The systolic pressure differences in the day-time and at night in VVS group were lower than those of the control group (P <0.05), and they decreased by 20.58%. There were no significant differences in the diastolic pressure of differences in the daytime and at night in VVS group were lower than those of the control group(P >0.05), and they decreased by 3.1%.24hSBP,24hDBP, DSBP, DDBP, NSBP, NDBP were not significant differ- ences in male children with VVS than those of female children with VVS(P<0.05).②24-hour mean systolic pressure load (24hSBPL),24-hour mean diastolic pressure load(24hDBPL), daytime mean systolic pressure load (DSBPL), daytime mean diastolic pressure load(DDBPL), nighttime mean systolic pressure load (NSBPL), nighttime mean diastolic pressure load (NDBPL) in VVS were higher than those of control group(P<0.05). DSBPL, DSBPL and DDBPL in VVS children were higher than NSBPL and NDBPL (P<0.05), respectively.But there were no significant differences in 24hSBPL, 24hDBPL, DSBPL, DDBPL, NSBPL, NDBPL in male children with VVS and those of female children with VVS.③24hSBP,24hDBP, DSBP, DDBP in the spoon pressure pattern in VVS group were higher than those of non-spoon pressure pattern with VVS (P>0.05). NSBP (P>0.05), NDBP (P<0.05) in the non-spoon pressure pattern in VVS group were higher than those of spoon pressure pattern with VVS. The systolic pressure differences in the day-time and at night and the diastolic pressure differences in the day-time and at night in the non-spoon pressure pattern in VVS group were higher than those of spoon pressure pattern with VVS (P<0.05).24hSBPL,24hDBPL DSBPL, DDBPL in the spoon pressure pattern in VVS group were higher than those of non-spoon pressure pattern with VVS (P>0.05). NSBPL, NDBPL of the non-spoon pressure pattern in VVS group were higher than those of spoon pressure pattern with VVS.④The non-spoon pattern rate of fluctuation curve of ambulatory blood pressure in VVS group was higher than that of the control group (66.67% vs 17.50%, P<0.05). But it was not significantly different between male children and female children in VVS group (P>0.05). The specificity, sensitivity, diagnostic coincidence, positive predict value, negative predict value of ambulatory blood pressure pattern to VVS was 82.5%,66.67%,72.32%,87.27%,57.89%, respectively. The Youden index was 45.28%.Conclusion:①here was autonomic nerve adjustment imbalance in pediatric patients with VVS during asymptomatic time periods, especially the sympathetic nerve.②he non-spoon pattern rate of fluctuation curve of ambulatory blood pressure in VVS children was high, nighttime blood pressure in children with VVS was significantly increased, that is because nocturnal sympathetic nerve activety increase in pediatric patients with VVS.