心脏自主神经系统调节在儿童血管迷走性晕厥中的研究现状

doi:10.12372/jcp.2022.22e0413

摘要/Abstract

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的一种类型,其发病机制复杂。自主神经系统包括交感神经和副交感神经,心脏受两者双重支配并保持平衡。目前普遍认为VVS存在心脏自主神经调节功能的失衡。文章就VVS中心脏自主神经主要神经递质的作用、心脏自主神经功能的评价指标及针对自主神经功能失衡的治疗等方面的研究进展作一介绍。

关键词: 自主神经系统, 血管迷走性晕厥, 神经递质, 自主神经功能检测, 治疗

Abstract:

Vasovagal syncope (VVS) is the commonest type of autonomic nerve mediated syncope, and the pathogenesis of VVS is complex. The autonomic nervous system consists of the sympathetic nervous system and the parasympathetic nervous system. The two systems keep the cardiac balance. It is generally accepted that VVS has the imbalance of cardiac autonomic nerve regulation. In this paper, we summarize the research results about the role of cardiac autonomic nerves and their major neurotransmitters, application of cardiac autonomic nerve function tests, and treatment of autonomic nerve dysfunction in VVS.

Key words: autonomic nervous system, vasovagal syncope, neurotransmitter, autonomic nerve function test, treatment

徐萌, 谢利剑. 心脏自主神经系统调节在儿童血管迷走性晕厥中的研究现状[J]. 临床儿科杂志, 2022, 40(7): 494-499.

XU Meng, XIE Lijian. Research status of cardiac autonomic nervous system regulation in vasovagal syncope in children[J]. Journal of Clinical Pediatrics, 2022, 40(7): 494-499.

图/表 1

参考文献 39

[1]	Kenny RA, Mcnicholas T. The management of vasovagal syncope[J]. QJM, 2016, 109(12): 767-773. doi: 10.1093/qjmed/hcw089 pmid: 27340222
[2]	Li HX, Gao L, Yuan Y. Advance in the understanding of vasovagal syncope in children and adolescents[J]. World J Pediatr, 2021, 17(1):58-62. doi: 10.1007/s12519-020-00367-z
[3]	李旭, 刘文玲. 神经内分泌激素在血管迷走性晕厥发生中的作用[J]. 中国循环杂志, 2022, 37(1): 97-100.
[4]	Benditt DG, van Dijk JG, Krishnappa D, et al. Neurohormones in the pathophysiology of vasovagal syncope in adults[J]. Front Cardiovasc Med, 2020, 7: 76. doi: 10.3389/fcvm.2020.00076 pmid: 32478097
[5]	Kohno R, Detloff BLS, Chen LY, et al. Greater early epinephrine rise with head-up posture: a marker of increased syncope susceptibility in vasovagal fainters[J]. J Cardiovasc Electrophysiol, 2019, 30(3): 289-296. doi: 10.1111/jce.13792
[6]	Liu C, Jiang H, Yu L, et al. Vagal stimulation and arrhythmias[J]. J Atr Fibrillation, 2020, 13(1):2398.
[7]	石赟, 田宏, 桂永浩, 等. 一氧化氮和内皮型一氧化氮合成酶与血管迷走性晕厥发病的关系[J]. 中国当代儿科杂志, 2008, 10(4): 478-480.
[8]	Stewart JM, Sutton R, Kothari ML, et al. Nitric oxide synthase inhibition restores orthostatic tolerance in young vasovagal syncope patients[J]. Heart, 2017, 103:1711-1718. doi: 10.1136/heartjnl-2017-311161 pmid: 28501796
[9]	中华医学会儿科学分会心血管学组, 中华儿科杂志编辑委员会, 北京医学会儿科学分会心血管学组, 等. 儿童晕厥诊断指南(2016年修订版)[J]. 中华儿科杂志, 2016, 54(4): 246-250.
[10]	Brignole M, Moya A, de Lange FJ, et al. 2018 ESCGuidelines for the diagnosis and management of syncope[J]. Eur Heart J, 2018, 39(21):1883-1948. doi: 10.1093/eurheartj/ehy037
[11]	何坤, 董湘玉. 儿童血管迷走性晕厥研究进展[J]. 兰州大学学报(医学版), 2019, 45(2): 81-87.
[12]	Shim SH, Park SY, Moon SN, et al. Baseline heart rate variability in children and adolescents with vasovagal syncope[J]. Korean J Pediatr, 2014, 57(4): 193-198. doi: 10.3345/kjp.2014.57.4.193 pmid: 24868217
[13]	童可, 何爽, 明黎, 等. 血管迷走性晕厥患儿无症状期自主神经功能分析[J]. 临床儿科杂志, 2020, 38(9): 665-670.
[14]	Evrengul H, Tavli V, Evrengul H, et al. Spectral and time-domain analyses of heart-rate variability during head-upright tilt-table testing in children with neurally mediated syncope[J]. Pediatr Cardiol, 2006, 27(6): 670-678. pmid: 17072674
[15]	孙巍, 郑黎晖, 姚焰, 等. 血管迷走性晕厥患者的心率减速力和心率变异性特征[J]. 中国循环杂志, 2015, 30(11): 1067-1070.
[16]	张静, 郑彤, 林瑶, 等. 血管迷走性晕厥患儿静息状态下心率减速力和心率变异性的变化[J]. 中华实用临床儿科杂志, 2019, 34(13): 986-989.
[17]	Zheng L, Sun W, Liu S, et al. The diagnostic value of cardiac deceleration capacity in vasovagal syncope[J]. Circ Arrhythm Electrophysiol, 2020, 13(12): e008659. doi: 10.1161/CIRCEP.120.008659
[18]	郑黎晖, 孙巍, 胡锋, 等. 左心房神经节丛消融对血管迷走性晕厥患者心率减速力的影响[J]. 中华心律失常学杂志, 2021, 25(4): 300-305.
[19]	Ziemssen T, Siepmann T. The investigation of the cardiovascular and sudomotor autonomic nervous system-a review[J]. Front Neurol, 2019, 10: 53. doi: 10.3389/fneur.2019.00053 pmid: 30809183
[20]	崔晓丽, 王成, 林萍, 等. 儿童血管迷走性晕厥24 h动态血压变化研究[J]. 中国实用儿科杂志, 2012, 27(10): 754-756.
[21]	Zou R, Wang S, Cai H, et al. Vitamin D defificiency in children with vasovagal syncope is associated with impaired circadian rhythm of blood pressure[J]. Front Neurosci, 2021, 12(15): 712462.
[22]	Onishi Y, Minoura Y, Chiba Y, et al. Daily dysfunction of autonomic regulation based on ambulatory blood pressure monitoring in patients with neurally mediated reflex syncope[J]. Pacing Clin Electrophysiol, 2015, 38(8): 997-1004. doi: 10.1111/pace.12661
[23]	Kusuki H, Tsuchiya Y, Mizutani Y. QT variability index is correlated with autonomic nerve activity in healthy children[J]. Pediatr Cardiol, 2020, 41(7): 1432-1437. doi: 10.1007/s00246-020-02399-8
[24]	Butta C, Tuttolomondo A, Casuccio A, et al. Use of QT intervals for a more accurate diagnose of syncope and evaluation of syncope severity[J]. Int J Clin Pract, 2014, 68(7): 864-870. doi: 10.1111/ijcp.12387
[25]	刘吉田, 王玉汶, 李芳, 等. QT间期离散度对儿童及青少年心脏抑制型血管迷走性晕厥的诊断效能及预后估测价值[J]. 中国小儿急救医学, 2021, 28(3): 192-197.
[26]	Kolarczyk E, Markiewicz-Łoskot G, Szydłowski L. The repolarization period during the head-up tilt test in children with vasovagal syncope[J]. Int J Environ Res Public Healt, 2020, 17(6): 1908. doi: 10.3390/ijerph17061908
[27]	Köse MD, Bağ Ö, Güven B, et al. P-wave dispersion: an indicator of cardiac auto- nomic dysfunction in children with neurocardiogenic syncope[J]. Pediatr Cardiol, 2014, 35(4): 596-600. doi: 10.1007/s00246-013-0825-y
[28]	王双双, 易秀英, 纪青, 等. 儿童青少年心脏抑制型血管迷走性晕厥心电图P波的变化及诊断价值[J]. 中国当代儿科杂志, 2019, 21(11): 1084-1088.
[29]	廖莹, 杜军, 保王成, 等. 儿童血管迷走性晕厥及体位性心动过速综合征治疗专家共识[J]. 中华儿科杂志, 2018, 56(1): 6-9.
[30]	Ballantyne BA, Letourneau-Shesaf S, Raj SR. Management of vasovagal syncope[J]. Auton Neurosci, 2021, 236: 102904. doi: 10.1016/j.autneu.2021.102904
[31]	姜敏, 蒙景雯, 刘平, 等. 直立不耐受自主神经功能锻炼患儿的依从性研究[J]. 中国医刊, 2021, 56(8): 888-891.
[32]	Bagrul D, Ece I, Yılmaz A, et al. Midodrine treatment in children with recurrent vasovagal syncope[J]. Cardiol Young, 2021, 31(5): 817-821. doi: 10.1017/S1047951120004746
[33]	杜朝阳, 周颖, 陈超阳, 等. 米多君治疗儿童血管迷走性晕厥有效性和安全性的Meta分析[J]. 中国临床药理学杂志, 2020, 36(13): 1890-1893.
[34]	董童, 牛少敏, 刘亚红, 等. 美托洛尔和米多君治疗血管迷走性晕厥meta分析[J]. 中国实用儿科杂志, 2018, 33(5): 353-359.
[35]	Atici A, Rasih-Sonsoz M, Ali-Barman H, et al. The role of beta-1 receptor gene polymorphism in beta-blocker therapy for vasovagal syncope[J]. Rev Invest Clin, 2020, 72(5): 300-307.
[36]	Yao Y, Shi R, Wong T, et al. Endocardial autonomic denervation of the left atrium to treat vasovagal syncope: an early experience in humans[J]. Circ Arrhythm Electrophysiol, 2012, 5(2): 279-286. doi: 10.1161/CIRCEP.111.966465
[37]	Hu F, Zheng L, Liang E, et al. Right anterior ganglionated plexus: the primary target of cardioneuro ablation?[J]. Heart Rhythm, 2019, 16(10): 1545-1551. doi: 10.1016/j.hrthm.2019.07.018
[38]	颜如玉, 朱世杰, 赵海玉, 等. 射频导管消融术治疗血管迷走性晕厥的进展[J]. 心血管病学进展, 2020, 41(12): 1231-1233.
[39]	Aksu T, Erdem Guler T. Cardioneuroablation in the management of vasovagal syncope, sinus node dysfunction and functional atrioventricular block: patient selection based on supporting evidence[J]. J Atr Fibrillation, 2020, 13(1): 2396.