Nörokardiyojenik Senkoplu Çocuk ve Adölesanlarda Tanı, Tedavi ve İzlem Sonuçlarının Değerlendirilmesi

Year 2010, , 190 - 197, 01.10.2010

Yakup Ergül Kemal Nişli Erkin Rahimov Elif Erdem Özcan Ümrah Aydoğan Rukiye Eker Ömeroğlu Aygün Dindar

https://doi.org/10.5222/j.child.2010.190

Abstract

Amaç: Yineleyen senkop yakınmasıyla başvuran hastalarda bazal ve izosorbid dinitrat İSDN ile uyarılmış tilt testi sonuçları, tedavi biçimleri ve izlemlerinin sunulması. Yöntemler: Çalışmamıza yineleyen senkop yakınmasıyla başvurup, kardiyak ve nörolojik tablolar dışlandıktan sonra tilt testi yapılan ve en az 1 yıl süreyle izlemde kalan hastalar alındı. Yaşları 9-18 yıl arasında değişmekteydi. Tilt testi protokolünde hastalar öncelikle 70°’de 30 dk. değerlendirildi. Bulgu olmayanlar 400 µg dozunda İSDN sprey dilaltına uygulanarak 15 dk. boyunca izlendi. Bulgular: Tilt testi yapılan 61 hastanın ortalama yaşları 13,4±2 yıl, senkop sayıları 3.8±2.8’di. Hastaların 45’inde % 73.8 tilt testi pozitif olup, bunların 19’unda bazal tilt testi pozitifken, 26 hastada İSDN ile uyarılmış tilt testi pozitifti. İzlemde hastaların 23’ü % 37.8 konservatif önlemlerle izlenirken, 38 hastaya [31 hastaya metoprolol, 6 hastaya propranolol, bir hasta kombine metoprolol, mitodrin, fludrokortizon, fluoksetin tedavi] ilaç başlandı. Yalnızca beta-bloker tedavi alan 37 hastanın % 21’inde başta baş ağrısı olmak üzere karın ağrısı, kusma ve bir hastada depresif davranışlar ortaya çıktı. Hastaların ortalama izlem süreleri 20±9 aydı. Hastaların % 19,6’sında senkopların yinelediği görüldü. Senkopların yinelemesi açısından tilt testi pozitif ve negatif olanlar ile ilaç tedavisi alan ve almayanlar arasında anlamlı fark saptanmadı. Sonuç: Yineleyen ve açıklanamayan senkoplu çocuk hastaların tanısında ISDN ile uyarılmış tilt test protokolü uygulanabilir. Hastaların senkop yinelemesi riskini belirlemede tilt testi sonuçlarının fazla önemi yok gibi görünmektedir. Medikal tedavinin senkop tekrarlarını önlemedeki rolünü ortaya koymak için daha ileri çalışmalara gereksinim vardır.

Keywords

Senkop, tilt testi, beta-bloker, çocuk, adölesan

Evaluation of Outcomes of Treatment and Long Term Follow-up in Children and Adolescents with Neurocardiogenic Syncope

Abstract

Objective: To evaluate the response to treatment and longterm follow-up of the children with recurrent syncope who underwent a basal-isosorbide dinitrate ISDN stimulated head-up tilt table test HUT Methods: The patients with recurrent syncope, excluding those with cardiac and neurologic etiologic factors underwent a HUT and followed up for at least one year while undergoing treatment. The age of the patients ranged between 9-18 years. In the HUT protocol, patients were evaluated at 70° angle for 30 minutes initially and if necessary, 400 µg ISDN spray was applied sublingually for 15 minutes. Results: The study was performed on 61 patients. The mean age of the patients was 13.4±2 years and the mean number of recurrent syncopes was 3.8±2.8. The test was found to be positive on 45 patients 73.8 % 19 basal-26 ISDN stimulated . Twenty-three patients were followed up with conservative therapy. Medical therapy was started on 38 patients [metoprolol, n= 31, and propranolol, n= 6 , and combination therapy metoprolol, midodrine, fludrocortisone and fluoxetine, n=1 . In 8 out of 37 patients who were given betablocker therapy, mainly headache, and also abdominal pain, vomiting, depressive symptoms n=1 were observed. The average follow- up period was 20±9 months. Syncope recurred in 7 patients. There was no significant difference between tilt test positive and negative groups and among patients either on medical therapy or not regarding to the recurrences of syncopes. Conclusion: ISDN stimulated tilt test protocol can be performed in pediatric patients with diagnoses of recurrent and unexplained syncope. However it has not been found to be predictive for the risk of recurrences. We believe that further studies are needed to document the benefit of medical therapy to prevent the recurrent syncope episodes.

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