| Objective: To investigate the history of vasovagal syncope(VVS)in children and its characteristics in head-up tilt test(HUTT),and search for warning indicators before syncope in HUTT.In this way,early recognition of VVS positive reactions can reduce the risk of cardiovascular events during the examination,and provide reference for clinicians to monitor the vital signs of children and deal with emergencies.Methods:A retrospective analysis was performed on the medical history,clinical manifestations,electrocardiogram(ECG)characteristics and early warning indicators of positive reactions of children diagnosed with neurally mediated syncope(NMS)by HUTT in our hospital from January 2018 to August 2019.Result:1.General data: a total of 90 cases were collected,and HUTT results were VVS in 41 cases,including 18 males and 23 females.There were 49 patients in the negative group,including 26 males and 23 females.There was no significant difference in gender and body mass index between the two groups.The mean age of the VVS group(11.59±1.94)was higher than that of the negative group(10.59±2.10),and the difference was statistically significant(t=-2.364,p=0.020).2.History: the number of patients in the VVS group with persistent onset was higher than that in the negative group,and the difference was statistically significant(2=7.22,p=0.011).The number of blurred visual objects in the VVS group was higher than that in the negative group,and the difference between the two groups was statistically significant(2=5.854,p=0.019).Other medical characteristics,such as postural position before syncope,mode of remission,state after onset,previous history,family history,diet and drinking habits,were not statistically significant.3.Based head-up tilt test(BHUT): the clinical manifestations of chest distress were 1(2%)in the negative group and 9(22%)in the VVS group,with significant statistical difference(2=7.057,p=0.008).4.Sublingual nitroglycerin head-up tilt test(SNHUT): VVS group of dizziness,chest tightness,pale face,nausea,blurred vision,fatigue,fever increased obviously,the two groups was statistically difference.5.There were 3 patients with serious adverse reactions in HUTT,all of which occurred in the stage of SNHUT.1 patient showed only loss of consciousness for 7min,and 1 patient showed loss of consciousness and aphasia for 18 min.One case showed simultaneous loss of consciousness,convulsion and cardiac arrest for 14 s.With a low incidence of serious adverse reactions,the patients were immediately supine,raised and massaged both lower limbs,and chest compressions were given when necessary.All the children were able to fully regain consciousness within a short time.6.Ecg changes: in HUTT,the VVS group had more vertical t-wave changes,and there was a statistical difference between the negative group and the VVS group(2=16.131,p=0.000).7.Characteristics of heart rate change: among the 41 VVS,38 cases occurred in the drug stimulation test,and the VVS positive reaction time was mostly between 5 and 10 min after the drug test,with an average time of 6.8mim.Moreover,the heart rate of 25 cases(65.7%)increased by ?30 beats/min on average after the start of the drug test compared with the basic heart rate before the test.8.Binary Logistic regression analysis showed that presyncope blurred vision and prolonged standing were independent risk factors for VVS positive reactions in HUTT.Conclusion: VVS in children have its clinical characteristics,so the patient history should be inquired carefully before HUTT.Through close observation and comprehensive analysis of the clinical manifestations,heart rate changes and ecg changes in HUTT,the occurrence of positive reactions in HUTT can be warned in advance to a certain extent and the risk of examination can be reduced. |
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