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目的总结小儿心源性晕厥病例的治疗经验。方法研究对象为1997年1月至2008年3月广东省人民医院收治的心源性晕厥患儿57例,其中男25例,女32例;年龄平均(3.0±3.9)岁(0.6~14岁)。35例法洛四联症缺氧发作晕厥的病例予β受体阻滞剂及心脏手术治疗。9例Ⅲ度房室阻滞晕厥病例予心室起搏及针对基础心脏疾病治疗。5例长QT综合征(LQTS)晕厥发作的病例分别予美西律、β受体阻滞剂及联合起搏治疗。致心律失常性右室心肌病及扩张型心肌病室性心动过速晕厥的病例予电击复律、索他洛尔、胺碘酮等治疗。室颤及电机械分离病例予除颤等复苏急救及治疗原发心脏病。患儿出院后均予随诊。结果50例住院期间晕厥得到控制,住院期间死亡3例。本组随访时间1个月至10年,5例出院后失访。随访中45例无晕厥发作,1例晕厥发作减少,2例仍反复发作,1例死亡。结论心源性晕厥除治疗引发晕厥的直接因素外,还应积极治疗原发心脏疾病。单纯药物治疗只对部分病例有效,药物联合起搏或联合植入型心脏复律除颤器有望在恶性心律失常晕厥病例治疗中发挥重要作用。
Objective To summarize the experience of treatment of pediatric cardiac syncope. Methods From January 1997 to March 2008, 57 cases of cardiogenic fainting were admitted to Guangdong Provincial People’s Hospital, including 25 males and 32 females. The average age was 3.0 ± 3.9 years ). 35 cases of tetralogy of Fallot hypoxia syncope cases of β-blockers and cardiac surgery. 9 cases of Ⅲ degree atrioventricular block syncope cases to ventricular pacing and treatment of basic heart disease. 5 cases of long QT syndrome (LQTS) syncope episodes were treated with mexiletine, β-blockers and pacing therapy. Induced arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy in patients with ventricular tachycardia syncope of the cardioversion, sotalol, amiodarone and other treatment. Ventricular fibrillation and electromechanical separation of cases to defibrillation and other recovery of first aid and treatment of primary heart disease. Children were followed up after discharge. Results 50 cases of syncope during hospitalization were controlled, died during hospitalization in 3 cases. This group was followed up for 1 month to 10 years, 5 were lost to hospital after discharge. No follow-up of 45 cases of syncope, 1 case of syncope decreased, 2 cases were recurrent, 1 case of death. Conclusion Cardiac syncope in addition to the treatment of syncope caused by direct factors, but also should actively treat the primary heart disease. Pure drug therapy is only effective in some cases, drug pacing or implantable cardioverter-defibrillator is expected to play an important role in the treatment of malignant arrhythmia syncope.