摘要目的：探讨神经介导性晕厥（NMS）儿童应用口服补液盐（ORS）[Ⅰ]治疗前后血清及尿电解质的变化。方法2014年5月至2015年4月因不明原因晕厥及晕厥先兆等症状在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的患儿135例。男60例，女75例；年龄4～16（10．20±2．68）岁。完成直立倾斜试验（HUTT），同时完善血清和24 h 尿电解质检查，比较 HUTT 不同血流动力学类型患儿血清和24 h 尿电解质。HUTT 阳性者予健康教育和 ORS[Ⅰ]治疗，HUTT 阴性者仅予健康教育。21～154（42．63±27．71）d 后来院复诊，询问症状改善情况，复查 HUTT 及血清、24 h 尿电解质。结果1．ORS[Ⅰ]治疗总有效率为62．96％（17／27例），HUTT 转阴率为48．15％（13／27例）。2．初诊 HUTT 阳性组与 HUTT 阴性组在血清电解质、24 h 尿电解质及24 h 尿量比较，差异均无统计学意义（P 均＞0.05）。3．复诊 HUTT 阳性组较 HUTT 阴性组在血清钙[（2．30±0．10）mmol／L 比（2．20±0．09）mmol／L，t ＝2．72，P ＜0.05]、血清磷[（1．73±0．22）mmol／L 比（1.51±0.23）mmol／L，t ＝2．671，P ＜0．05]增加，在血清钠、钾、氯、镁及24 h 尿电解质、24 h 尿量的差异均无统计学意义（P 均＞0．05）。4．ORS[Ⅰ]治疗后24 h 尿钠[（159．06±72.76）mmol／24 h 比（118．97±52．75） mmol／24 h，t ＝2．712，P ＜0．05]、24 h 尿氯[（139．08±66．53）mmol／24 h 比（111．34±47．33）mmol／24 h，t ＝2.116，P ＜0．05]及24 h 尿量[（1564．21±829．39）mL 比（1058．95±509．92）mL，t ＝3．371，P ＜0．01]较治疗前明显增加，差异有统计学意义；血清电解质及24 h 尿钾、钙、磷、镁治疗前后的差异均无统计学意义（P 均＞0．05）。5．初诊 HUTT 阳性的血管迷走性晕厥组和体位性心动过速综合征组在血清、尿电解质比较，差异均无统计学意义（P 均＞0．05）。结论ORS[Ⅰ]治疗后能明显增加 NMS 儿童24 h 尿钠、尿氯，为治疗 NMS 的有效方法。

abstractsObjective To explore the changes in serum and urine electrolytes of children with neurally media-ted syncope (NMS)after oral rehydration salts (ORS)[Ⅰ]treatment.Methods The study group included 135 patients [60 male and 75 female,aged 4 -16 years,average of (10.20 ±2.68)years old]with unexplained syncope and prodro-mal symptoms of syncope in our hospital between May 2014 and April 2015.The patients underwent head -up tilt test (HUTT),and completed serum electrolytes and 24 -hour urine electrolytes,and the serum electrolytes and 24 -hour u-rine electrolytes in different hemodynamic type of HUTT were compared.Positive HUTT patients were treated with health education and ORS[Ⅰ],while negative HUTT patients were received health education.Then 21 -154(42.63 ±27.71) days later,the patients returned to hospital,for the inquiry of symptom improvement,and review of HUTT,24 -hour urine and serum electrolytes.Results (1)The total effective rate of ORS[Ⅰ]treatment was 62.96% (17 /27 cases),while negative conversion rate of HUTT was 48.15% (13 /27 cases).(2)There was no significant difference in serum electro-lytes,24 -hour urine electrolytes or 24 -hour urine volume between HUTT positive group and negative group during the first visit (all P >0.05).(3)In return visit,serum calcium [(2.30 ±0.10)mmol/L vs (2.20 ±0.09)mmol/L,t =2.72,P <0.05]and serum phosphorus [(1.73 ±0.22)mmol/L vs (1.51 ±0.23)mmol/L,t =2.671,P <0.05]in HUTT positive group were significantly higher than those in negative group.The serum sodium,potassium,chloride,mag-nesium and 24 -hour urine electrolytes,24 -hour urine volume had no statistical difference(all P >0.05).(4)24 -hour urine sodium [(159.06 ±72.76)mmol/24 h vs (118.97 ±52.75)mmol/24 h,t =2.712,P <0.05],24 -hour urine chloride [(139.08 ±66.53)mmol/24 h vs (111.34 ±47.33)mmol/24 h,t =2.116,P <0.05]and 24 -hour urine volume [(1 564.21 ±829.39)mL vs (1 058.95 ±509.92)mL,t =3.371,P <0.01]after ORS[Ⅰ]treatment were sig-nificantly higher than those before ORS[Ⅰ]treatment.The serum electrolytes and 24 -hour urine potassium,calcium, phosphorus,magnesium had no statistical difference (all P >0.05).(5)There was no significant difference in serum elec-trolytes,24 -hour urine electrolytes or 24 -hour urine volume between vasovagal syncope group and postural orthostatic&nbsp;tachycardia syndrome group during the first visit(all P >0.05).Conclusions ORS[Ⅰ]treatment can obviously increase the 24 -hour urine sodium,24 -hour urine chloride in children with NMS.ORS[Ⅰ]is an effective therapy for NMS.