儿童院外心室颤动心脏骤停幸存者心前驱症状研究
本研究回顾了58例0至18岁无既往病因诊断的院外心脏骤停（OHCA）幸存儿童，发现约半数（50.9%）在心脏骤停前报告过心脏症状，其中晕厥最为常见（23.6%）。多数患儿事后被诊断为遗传性心脏病（72.4%），最常见为肥厚型心肌病（29.8%）。研究强调前驱症状是识别潜在心脏疾病的重要机会。
要点
- 约半数儿童OHCA幸存者存在心前驱症状，晕厥是最常见警示信号。
- 72.4%的患儿最终被诊断为遗传性心脏病，肥厚型心肌病占比最高。
- 有晕厥史患儿仅少数就医，提示公众和医学教育需加强识别「红旗」症状。
核心结论
- 儿童OHCA幸存者中，约半数在事件前有心脏警示症状，晕厥是突出表现，代表了识别潜在致病性心脏疾病的潜在机会。
研究设计与样本
- 研究为单中心回顾性队列研究，纳入1996至2025年间英国某儿科三级转诊中心连续58例0至18岁、无既往致病性诊断的OHCA幸存者。
主要发现
- 心脏骤停中位年龄为11岁（IQR 7–14岁），50%发生于用力时。
- 72.4%（42例）被诊断为遗传性心脏病，其中肥厚型心肌病占29.8%（17例）。
- 31.0%（18例）有猝死家族史。
- 50.9%（28例）报告过心前区症状，其中晕厥占23.6%（13例）。
关键数值与推荐
- 心脏骤停估计发生率为每10万人年9例，总体生存率低于10%。
- 在13例有晕厥史患儿中，仅3人曾就医，且均未安排随访。
临床怎么用
- 儿科评估中应重视晕厥及用力相关症状，特别是结合家族猝死史，主动筛查遗传性心脏病可能。
- 需提高临床医生及公众对儿童心脏「红旗」症状的认知，促进早期转诊与诊断。
局限性
- 研究为单中心小样本回顾性设计，可能存在选择偏倚及信息回忆偏倚。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Background Out-of-hospital cardiac arrest (OHCA) in children is a rare but devastating event, with an estimated incidence of 9 per 100 000 person-years and a survival rate of less than 10%. OHCA may be the presenting event in children with undiagnosed cardiovascular disease. A substantial proportion of adults experiencing an unexpected OHCA report previous symptoms, but whether the same is true in paediatric survivors has not been systematically evaluated previously. This study aims to describe cardiac symptoms in children prior to presenting with OHCA. Methods Clinical characteristics and preceding symptoms of 58 consecutive patients aged 0–18 without a pre-existing causative diagnosis presenting with a survived OHCA between 1996 and 2025 to a single UK paediatric tertiary referral centre were reviewed. Results The median age at cardiac arrest was 11 years (IQR 7–14 years). 29 OHCA (50%) occurred on exertion. Following the OHCA, 42 patients (72.4%) were diagnosed with an inherited cardiac condition, most commonly hypertrophic cardiomyopathy (n=17, 29.8%). 18 patients (31.0%) had a family history of sudden cardiac death. 28 patients (50.9%) had reported cardiac symptoms prior to their OHCA, including 13 (23.6%) who had experienced syncope. Of the 13 patients who experienced syncope, only three sought medical attention and none had follow-up arranged. Conclusions Almost half of paediatric OHCA survivors had warning symptoms prior to their event, representing potential missed opportunities to identify an underlying diagnosis prior to OHCA. These findings highlight the need for more education, both for medical professionals and the general public, about ‘red flag’ symptoms.
引用
- Open Heart：Cardiac warning symptoms in paediatric out-of-hospital ventricular fibrillation cardiac arrest survivors
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。