血管迷走性晕厥患儿直立倾斜试验及物理反压动作诊治及研究进展

Diagnosis, Treatment and Research Progress of Head-Up Tilt Test and Physical Back Pressure Action in Children with Vasovagal Syncope

摘要: 血管迷走性晕厥(vasovagal syncope, VVS)是自主神经介导性晕厥中最常见，也是儿童晕厥类型最普遍的一种疾病，其发病机制复杂不清，目前尚无定论。随着愈来愈多儿童罹患VVS，其诊疗仍是一研究热点。直立倾斜试验(head-up tilt test，HUTT)为VVS辅诊的首要方式，对患儿VVS分型及诊断起到了至关重要的作用。一般预后好，但近年研究发现部分患儿会出现猝死、有危及生命的风险，严重影响学习和生活质量。一线治疗即非药物治疗，其中健康教育和物理反压动作(PCMs)被推崇，简单方便，升压速度快。PCMs通过调节自主神经活性、释放神经递质改善晕厥，降低复发率，是急救的首要方式。HUTT通过降低交感神经和/增高迷走神经活性复刻晕厥场景，监测心率、血压等关键指标，有助于评估及预测VVS的复发。本文将结合国内外大量文献就自主神经功能在VVS中发挥的作用及HUTT、PCMs对VVS患儿的诊疗进行详细阐述。

Abstract: Vasovagal syncope (VVS) is the most common type of autonomic nerve-mediated syncope and the most common type of syncope in children. Its pathogenesis remains complex and not fully understood. With more and more children suffering from VVS, its diagnosis and treatment is still a research hotspot. The head-up tilt test (HUTT) is the primary method for auxiliary diagnosis of VVS, and it plays a crucial role in classifying and diagnosing VVS in children. Research indicates that the diagnostic accuracy of HUTT can vary among physicians, with those having a moderate level of experience being more likely to report a positive result. For instance, a study conducted at the Fuwai Hospital suggests that physicians with a moderate cumulative workload in performing HUTT tests tend to report a higher rate of suspicious positive cases. Generally, the prognosis is good, but in recent years, studies have found that some children may face sudden death and life-threatening risks, thereby severely impacting their education and overall well-being. The first-line treatment is non-drug treatment. Among these, health education and physical countermeasures (PCMs) are currently recognized as effective. They present no contraindications, are simple and convenient, and provide rapid efficacy. The PCMs treatment method is equally suitable for immediate first aid and serves as the primary approach for emergency response. PCMs improve syncope and reduce the recurrence rate by regulating autonomic nerve activity and releasing neurotransmitters. HUTT reproduces syncope scenes by modulating autonomic nervous system activity, and monitoring heart rate, blood pressure, and other vital signs to evaluate and analyze the patient’s condition. This article will integrate a comprehensive review of international and domestic literature to detail the significance of cardiac autonomic function in the diagnosis and treatment of vasovagal syncope (VVS) in children, with a focus on the use of head-up tilt testing (HUTT) and PCMs.