摘要目的 回顾性分析单中心儿童、青少年境遇性晕厥的病因构成及转归.方法 2000年1月至2017年11月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的具有不明原因晕厥、晕厥先兆等直立不耐受症状的儿童、青少年4 274例,年龄2～18岁[(10.82 ± 3.13)岁];男2 208例,女2 066例.经详细询问病史、仔细体格检查、常规12导联心电图、Holter心电图、心脏 X线、超声心动图、脑电图、头颅 CT或磁共振成像(MRI)、血液生化检查(包括空腹血糖、心肌酶)等排除器质性心、脑、血管疾病等,其晕厥原因仍不明确,在取得患儿和/或监护人书面知情同意后,行直立倾斜试验(HUTT)检查.结果 4 274例中符合境遇性晕厥177例(4.14%),病因构成依次为升旗(35.59%,63/177例)、排尿(24.29%,43/177例)、洗澡(9.60%,17/177例)、排便(7.34%,13/177例)、唱歌(5.08%,9/177例)、乘车(4.52%,8/177例)、晕血(3.95%,7/177例)、吞咽(3.39%,6/177例)、梳头(2.82%,5/177例)、晕针(2.26%,4/177例)、咳嗽(1.13%,2/177例).晕厥时常见体位依次为立位(84.18%,149/177例)、蹲位改立位(8.47%,15/177例)、坐位(5.08%,9/177例)、蹲位(2. 26%,4/177例).HUTT阳性率为69.49%(123/177例),常见血流动力学类型为血管迷走性晕厥血管抑制型(45.20%,80/177例)、血管迷走性晕厥混合型(19.77%,35/177例)、体位性心动过速综合征(3.39%,6/177例)及血管迷走性晕厥心脏抑制型(1.13%,2/177例).35例境遇性晕厥儿童、青少年经健康教育及直立训练2～16周[(4.97 ± 3.16)周]后晕厥次数明显减少.第1次复查由最初晕厥(2.69 ± 1.81)次减少至(0.59 ± 0. 96)次.8例第2次复查,其中3例未再晕厥,3例各晕厥1次,1例晕厥4次,1例晕厥2次.16例第1次复查HUTT结果转为阴性,3例第2次复查转为阴性.结论 儿童、青少年境遇性晕厥病因构成为升旗、排尿、洗澡、排便、唱歌、乘车、晕血、吞咽、梳头、晕针、咳嗽.健康教育后转归较好.

abstractsObjective To retrospectively analyze the etiology and prognosis of the children and adolescents with situational syncope in a single center.Methods There were 4 274 cases of children and adolescents [aged from 2 to 18 years old,the average age being (10.82 ± 3.13)years old],male 2 208 cases,female 2 066 cases with ortho-static intolerance syndromes,such as unexplained syncope or symptoms of presyncope,etc,who were treated at Children's Syncope Outpatient Department or Inpatient Department in the Second Xiangya Hospital,Central South University from January 2000 to November 2017.All subjects underwent detailed history investigation,careful physical examinations, routine 12-lead electrocardiogram,Holter electrocardiogram(ECG),chest X-ray,echocardiography,electroencephalo-gram(EEG)and head computerized tomography(CT)or magnetic resonance imaging(MRI),blood biochemical exami-nation (including fasting glucose,myocardial enzymes)and organic diseases in the heart,brain,blood vessels were ex-cluded,but the cause of syncope was still not clear.The head-up tilt table test (HUTT)was performed after the pa-tients or/and the families wrote the informed consent agreement.Results A total of 177 (4.14%)patients with situa-tional syncope were diagnosed among 4 274 cases.Etiology included the abdominal musecle exercise (35.59%,63/177 cases),urination (24.29%,43/177 cases),bathing (9.60%,17/177 cases),defecation (7.34%,13/177 cases), singing (5. 08%,9/177 cases),rides (4.52%,8/177 cases),blood-injection-injury phobia (3.95%,7/177 ca-ses),swallowing (3.39%,6/177 cases),and hair-grooming (2. 82%,5/177 cases),syncope during acupuncture treatment (2. 26%,4/177 cases),and cough (1.13%,2/177 cases). The common positions were upright position (84.18%,149/177 cases),squatting to standing position (8.47%,15/177 cases),sitting position (5.08%,9/177 cases),and squatting position (2.26%,4/177 cases).HUTT positive rate was 69.49%(123/177 cases),common type of hemodynamic were the vasodepressive type of vasovagal syncope (45.20%,80/177 cases),mixed type of vaso-vagal syncope (19.77%,35/177 cases),postural orthostatic tachycardia syndrome (3.39%,6/177 cases)and the cardiac suppressive type of vasovagal syncope (1.13%,2/177 cases).In 35 cases of situational syncope,the number of children and adolescents with syncope was significantly reduced by health education and upstanding training.By the first follow-up review,the cases were reduced from (2.69 ± 1.81)times to (0.59 ± 0.96)times after healthy edu-cation of 2-16 weeks [(4.97 ± 3.16)weeks].By the second follow-up review,3 out of 8 cases did not faint,3 cases fainted 1 time,1 case fainted 2 times,and 1 case fainted 4 times.The outcomes of the first reexamination of HUTT in 16 cases were negative,and other 3 cases were negative by twice visit.Conclusions The etiology of children and adoles-cents are flag-raising(abdominal muscle exercise),urination,bathing,defecation,singing,riding,blood-injection-injury phobia,swallowing,hair -grooming,syncope during acupuncture treatment and coughing. Healthy education is good for situational syncope.