郑州市中小学生不明原因晕厥及危险因素分析
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摘要
目的调查河南省郑州市中小学生不明原因晕厥发病率,并分析其危险因素,为预防不明原因晕厥提供有效建议。方法于2017年1月—2018年4月,采用分层整群抽样方法在郑州市随机抽取4 028名城乡中小学生,统计不明原因晕厥发病率、频次、诱发因素、晕厥先兆等,并分析影响晕厥发生的危险因素。结果郑州市中小学生有784例发生晕厥,占19.46%,其中51例有家族晕厥史,占6.51%,晕厥发生率随年龄增长呈逐步增高趋势;发生1次晕厥有427例,占54.46%;女生晕厥发病率明显高于男生(P <0.05);诱发因素中排便排尿诱发男生晕厥率明显高于女生,而闷热环境、久站诱发女生晕厥率明显高于男生(P <0.05);晕厥先兆中恶心呕吐、大汗、胸闷、头晕女生发病率明显高于男生(P <0.05);在中小学生晕厥持续时间中,数秒所占比例最高(51.15%),> 10 min所占比例最低(9.69%);在体位中,晕厥时站立位所占比例最高(73.72%),坐位所占比例最低(7.27%);年龄、性别、焦虑程度是不明原因晕厥发生的危险因素(均P <0.05)。结论郑州市中小学生不明原因晕厥发病率较高,随年龄增长呈上升趋势,年龄、性别、焦虑程度是其危险因素,对此应采取健康教育、减压、体育锻炼等措施预防晕厥发生。
Objective To investigate the incidence and its risk factors of unexplained syncope among primary and middle school students in Zhengzhou city, Henan province and to provide evidences for the prevention of unexplained syncope.Methods From January 2017 to April 2018, 4 028 urban and rural primary and secondary school students were randomly selected by stratified cluster sampling method in Zhengzhou, the incidence, frequency, inducing factors and the precursors of syncope were counted, and the risk factors affecting syncope were analyzed. Results 784(19.46%) reported the incident of syncope. Among the students, the self-reported syncope incidence increased with the increment of age and the incidence was significantly higher in the girl students than in the boy students(P < 0.05). Of the syncope cases, 427(54.46%) had the incident only once and 51(6.51%) reported family history of syncope; 51.15% had the syncope incident duration of several seconds and only 9.69% had the incident duration of more than 10 minutes; 73.72% had the incident when in standing position and 7.27% in sitting position. Significantly higher ratio of male syncope cases than the female cases reported the incident being induced by urination(P < 0.05), while significantly higher ratio of female than the male cases reported the incident being induced by hot and humid environment and long time of standing(both P < 0.05); the female syncope cases also reported significantly higher frequencies of premonitory symptoms as nausea and vomiting, heavy sweating, chest distress, and dizziness(all P < 0.05). The risk factors of unexplained syncope included age, gender, and anxiety among the students. Conclusion The incidence of unexplained syncope is relatively high and mainly influenced by age, gender and anxiety among primary and secondary school students in Zhengzhou city; health education on prevention of syncope should be promoted among the students.
Objective To investigate the incidence and its risk factors of unexplained syncope among primary and middle school students in Zhengzhou city, Henan province and to provide evidences for the prevention of unexplained syncope.Methods From January 2017 to April 2018, 4 028 urban and rural primary and secondary school students were randomly selected by stratified cluster sampling method in Zhengzhou, the incidence, frequency, inducing factors and the precursors of syncope were counted, and the risk factors affecting syncope were analyzed. Results 784(19.46%) reported the incident of syncope. Among the students, the self-reported syncope incidence increased with the increment of age and the incidence was significantly higher in the girl students than in the boy students(P < 0.05). Of the syncope cases, 427(54.46%) had the incident only once and 51(6.51%) reported family history of syncope; 51.15% had the syncope incident duration of several seconds and only 9.69% had the incident duration of more than 10 minutes; 73.72% had the incident when in standing position and 7.27% in sitting position. Significantly higher ratio of male syncope cases than the female cases reported the incident being induced by urination(P < 0.05), while significantly higher ratio of female than the male cases reported the incident being induced by hot and humid environment and long time of standing(both P < 0.05); the female syncope cases also reported significantly higher frequencies of premonitory symptoms as nausea and vomiting, heavy sweating, chest distress, and dizziness(all P < 0.05). The risk factors of unexplained syncope included age, gender, and anxiety among the students. Conclusion The incidence of unexplained syncope is relatively high and mainly influenced by age, gender and anxiety among primary and secondary school students in Zhengzhou city; health education on prevention of syncope should be promoted among the students.
引文
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[8]廖冬磊,许毅,吴礼嘉,等.神经介导性晕厥发作的昼夜节律性研究[J].中国循环杂志,2017,32(2):165-169.
[9]于侠,孙立双,韩立志,等.儿童晕厥的病因及临床特征分析[J].临床儿科杂志,2013,31(7):605-608.
[10]Numeroso F,Mossini G,Lippi G,et al.Role of emergency department observation units in the management of patients with unexplained syncope:a critical review and meta-analysis:[J].Clinical and Experimental Emergency Medicine,2017,4(4):201-207.
[11]王成,蔡虹.其他自主神经功能检查对不明原因晕厥儿童的定量诊断和危险评估[J].中华实用儿科临床杂志,2018,33(1):3-8.
[12]蔺婧,王瑜丽,张清友,等.儿童青少年晕厥疾病谱近30年变化及卫生经济学分析单中心报告[J].中国实用儿科杂志,2016,31(5):350-355.
[13]李茉,贾蕊,石玉杰,等.不明原因晕厥与心脏卵圆孔未闭高度相关[J].中国临床神经科学,2016,24(3):328-331.
[14]秦云,王成,徐慧,等.长沙市高等医学院校女生发生晕厥影响因素调查报告[J].临床误诊误治,2014,27(6):76-78.
[15]王磊,王立军,张启高,等.植入式心脏事件循环记录器诊断不明原因晕厥1例报告[J].东南国防医药,2015,17(4):386-388.
[16]雷礼琴,朱婉红.24小时动态心电图在不明原因晕厥患者临床诊断中的应用价值分析[J].实用心脑肺血管病杂志,2014,22(6):113-114.
[2]徐文瑞,金红芳,杜军保.进一步关注儿童晕厥的诊治[J].中国医刊,2016,51(5):1-2.
[3]Wieling W,Thijs RD,Linzer M,et al.Great expectations:what patients with unexplained syncope desire[J].J Intern Med,2016,279(3):259-264.
[4]Prochnau D,Lambert T,Sigusch H,et al.Predictors of future arrhythmic events in patients with unexplained syncope[J].Acta Cardiol,2017,72(5):530-535.
[5]Samakouri M,Bouhos G,Kadoglou M,et al.Standardization of the Greek version of Zung's Self-Rating Anxiety Scale(SAS)[J].Psychiatriki,2012,23(3):212.
[6]教育部体育卫生与艺术教育司,全国学生体质健康调研组.2014年全国学生体质健康调研工作手册[R].北京:教育部,2014:76-79.
[7]胡尔林,王成,贺宇轩,等.长沙市中小学生不明原因晕厥发病率及其影响因素分析[J].中华实用儿科临床杂志,2014,29(13):979-982.
[8]廖冬磊,许毅,吴礼嘉,等.神经介导性晕厥发作的昼夜节律性研究[J].中国循环杂志,2017,32(2):165-169.
[9]于侠,孙立双,韩立志,等.儿童晕厥的病因及临床特征分析[J].临床儿科杂志,2013,31(7):605-608.
[10]Numeroso F,Mossini G,Lippi G,et al.Role of emergency department observation units in the management of patients with unexplained syncope:a critical review and meta-analysis:[J].Clinical and Experimental Emergency Medicine,2017,4(4):201-207.
[11]王成,蔡虹.其他自主神经功能检查对不明原因晕厥儿童的定量诊断和危险评估[J].中华实用儿科临床杂志,2018,33(1):3-8.
[12]蔺婧,王瑜丽,张清友,等.儿童青少年晕厥疾病谱近30年变化及卫生经济学分析单中心报告[J].中国实用儿科杂志,2016,31(5):350-355.
[13]李茉,贾蕊,石玉杰,等.不明原因晕厥与心脏卵圆孔未闭高度相关[J].中国临床神经科学,2016,24(3):328-331.
[14]秦云,王成,徐慧,等.长沙市高等医学院校女生发生晕厥影响因素调查报告[J].临床误诊误治,2014,27(6):76-78.
[15]王磊,王立军,张启高,等.植入式心脏事件循环记录器诊断不明原因晕厥1例报告[J].东南国防医药,2015,17(4):386-388.
[16]雷礼琴,朱婉红.24小时动态心电图在不明原因晕厥患者临床诊断中的应用价值分析[J].实用心脑肺血管病杂志,2014,22(6):113-114.