Abstract:

Objective  To discuss the changes of ambulatory blood pressure monitoring（ABPM） in children with vasovagal syncope （VVS）.Methods A total of 72 children 〔VVS group，32 males，40 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 from Sep 2008 to Feb 2010.After confirmed diagnosis of VVS by positive head-up tilt test （HUTT），each patient was given ABPM.Forty healthy children （19 males，21 females，mean age 10.24 ± 2.01 years） were as controls （control group）.Parameters of ABPM in children were analyzed.SPSS 17.0 software was used for the statistical analysis of these data.Results （1）Mean pressure：24-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 （P＜0.05）.（2）Blood pressure pattern：the ratio of non-spoon pressure pattern was higher than that of spoon pressure pattern with VVS （67%vs.18%，P ＜0.05）.NDBP （P＜0.05） and NSBP （P ＞0.05） were decreased and the systolic pressure differences and diastolic pressure differences in the daytime and at nighttime were higher in spoon pressure pattern than those of non-spoon pressure pattern with VVS （P＜0.05）.（3）Diagnostic experimental evaluation：the specificity，sensitivity，diagnostic coincidence，positive predict value and negative predict value of non-spoon pattern of ambulatory blood pressure pattern to VVS was 82.5%，66.67%，72.32%，87.27% and 57.89%，respectively.The Youden index was 45.28%.Conclusion There is autonomic nerve adjustment imbalance in children with VVS during asymptomatic time periods，especially the sympathetic nerve.The non-spoon pattern rate of fluctuation curve of ambulatory blood pressure in VVS children is higher，which is of diagnosis value to VVS children.

Key words: vasovagal syncope, ambulatory blood pressure, autonomic nervous system, children

摘要：

目的    研究儿童血管迷走性晕厥（VVS）24 h动态血压监测（ABPM）血压变化情况。方法    选择2008年9月至2011年2月中南大学湘雅二医院就诊的不明原因晕厥（UPS）或晕厥先兆并经直立倾斜试验（HUTT）确诊为VVS患儿72 例（VVS组），其中男32 例，女40 例；年龄平均（10.98 ± 1.86） 岁。匹配同期来院体检健康儿童40 名为对照组，其中男19 名，女21 名；年龄平均（10.24 ± 2.01）岁。采用美国伟伦公司ABPM6100动态血压监测仪进行血压动态监测。结果    （1）平均血压变化：VVS组全天平均收缩压、全天平均舒张压、日间平均收缩压、夜间平均收缩压较对照组明显增高（P＜0.05）。（2）血压昼夜变化模式：VVS组呈现非勺型血压的比例明显高于健康对照组（67%、18%，P＜0.05）。VVS患儿勺型血压组与非勺型血压组比较，夜间平均舒张压明显降低（P＜0.05），夜间平均收缩压稍降低（P＞0.05），收缩压昼夜差值、舒张压昼夜差值明显增高（P＜0.05）。（3）诊断性试验评价：ABPM非勺型血压昼夜变化模式诊断VVS的特异度为82.50%，灵敏度为66.67%，总符合率为72.32%，阳性预测值为87.27%，阴性预测值为57.89%，约登指数为45.28%。结论    VVS患儿无症状期即存在自主神经调节失衡，以交感神经张力增加为主，且非勺型血压昼夜变化模式发生率高，对儿童VVS的诊断有一定临床价值。

关键词: 血管迷走性晕厥, 24h动态血压监测, 自主神经系统, 儿童