倾斜试验与倾斜训练诊治血管迷走性晕厥

目的探讨直立倾斜试验与倾斜训练对诊断和治疗血管迷走性晕厥（VVS）的临床应用。方法筛选适应证的病例12例，按统一的操作规程行倾斜试验，术中连续监测并记录血压及心电图变化，按有无晕厥或晕厥先兆来判断是否阳性，阳性者予以倾斜训练，随访观察发作次数与程度。结果倾斜试验12例，9例阳性，占75％；倾斜训练3例，1例有明显减少发作和减轻发作。     

一平苏对血管迷走性晕厥疗效观察

目的　观察一平苏对血管迷走性晕厥的疗效。方法　对 86例倾斜试验阳性晕厥患者给予一平苏 2 .5mg/d ,3月后复查倾斜试验并随访。结果　除 7例有咳嗷或其他原因退出试验外 ,余 79例倾斜试验阴转率为 75 .95 %。服药期间无一例发生晕厥。治疗前卧位血压为 12 1/73mmHg ,治疗后为 12 0 /76mmHg ,P >0 0 5。心率在治疗前后分别为 6 8± 13和 70± 13/min ,两者无显著性差异。结论　一平苏可以作为治疗血管迷走性晕厥的有效药物 ,副作用少 ,对正常血压和心率无影响。     

直立倾斜试验对血管迷走性晕厥的诊断价值分析

目的探讨直立倾斜试验对血管迷走性晕厥的诊断价值。方法选取2016年3月-2019年6月收治的血管迷走性晕厥患者157例进行研究,均采用直立倾斜试验,对其检测结果进行观察。结果157例患者中,阳性76例,其中血管抑制型21例,心脏抑制型2例,混合型53例。硝酸甘油激发试验阶段,阳性组低频标准化值下降,高频标准化值上升(P<0.05),阴性组无明显变化(P>0.05);服用硝酸甘油后,阴性组QTe/RR斜率、QTp/RR斜率上升(P<0.05),阳性组无明显变化(P>0.05)。结论直立倾斜试验对血管迷走性晕厥具有较高诊断价值,尤其是心率变异性频域指标与QT动态性指标可作为评估病情的主要参考依据。     

一平苏对血管迷走性晕厥疗效观察

目的观察一平苏对血管迷走性晕厥的疗效。方法对86例倾斜试验阳性晕厥患者给予一平苏2.5mg/d,3月后复查倾斜试验并随访。结果除7例有咳嗷或其他原因退出试验外,余79例倾斜试验阴转率为75.95%。服药期间无一例发生晕厥。治疗前卧位血压为121/73mmHg,治疗后为120/76mmHg,P>0.05。心率在治疗前后分别为68±13和70±13/min,两者无显著性差异。结论一平苏可以作为治疗血管迷走性晕厥的有效药物,副作用少,对正常血压和心率无影响。     

血管迷走性晕厥三种反应类型的心率变异性分析

本文通过观察 3种不同反应类型血管迷走性晕厥 (vaso vagalsyncope,VVS)患者在直立倾斜试验中 (head uptilttest,HUT)自主神经变化的特点 ,并对其进行心率变异性 (heartratevariability ,HRV)分析 ,为临床上进一步诊断和治疗不同亚型的VVS提供理论依据。资料和方法研究对象　选择 2 0 0 1～ 2 0 0 2年在我院住院及门诊就诊的不明原因晕厥患者 5 4例 ,年龄 15～ 5 8岁 ,均有明确晕厥病史 ,且末次晕厥在 3个月内 ,并经详细询问病史、体格检查、常规12导联心电图、2 4h动态心电图、超声心动图、X线胸片、颈椎片、头颅CT、血糖及血液生化…     

倾斜试验诊断血管迷走性晕厥的研究进展

倾斜试验可通过体位改变再现血管迷走性晕厥的发作。1986年英国学者Kenny首次将此应用于临床,目前已成为诊断和评价血管迷走性晕厥以及其他原因所致晕厥的重要有效方法,通过研究患者试验中的血流动力学反应有利于指导治疗。但目前倾斜试验尚无明确统一的试验方案,只是在主要程序步骤上达成了原则上的共识,因此对倾斜试验结果的判断要结合临床和试验方案。最近也有文章对其诊断价值提出了挑战,需要更多的研究明确评价倾斜试验。     

血管迷走性晕厥的诊断治疗手段及评价

血管迷走性晕厥(VVS)的诊断主要依靠详细的病史询问和体格检查,并排除其他类型的晕厥。目前认为直立倾斜试验(HUT)是诊断VVS的“金标准”。HUT检查阴性的部分所谓不明原因晕厥的VVS病人可通过植入性心电记录仪进行诊断。偶发VVS不需要特别处理,复发性VVS及部分特殊人群才需要进一步的诊治。目前VVS尚无有效的根治方法,其治疗以预防发作为主,包括患者教育、一般治疗、药物治疗(β-受体阻滞剂、盐皮质激素、抗胆碱能药物、选择性5-羟色胺重吸收抑制剂、α-受体激动剂)及起搏器治疗等几个方面。     

倾斜试验用于诊断血管迷走性晕厥的建议

血管迷走性晕厥（ｖａｓｏｖａｇａｌｓｙｎｃｏｐｅ，简称ＶＶＳ）是诸多晕厥中既特殊又常见的一种类型，过去是在排除其它类型晕厥的基础上诊断的，故诊断步骤复杂、费时。倾斜试验是诊断ＶＶＳ的一项特殊性检查，有助于确定诊断。为了规范化地开展此项检查，综合有关倾...     

年龄和性别对直立倾斜试验诊断血管迷走性晕厥结果的影响

目的：探讨年龄和性别对疑似血管迷走性晕厥（VVS）患者进行直立倾斜试验(HUTT)诊断结果的影响。
　　方法：收集2008-08至2012-12在阜外心血管病医院进行HUTT检查的患者共1223例,其中男性549例。患者年龄7~79岁,按年龄依次分为≤20岁组、21~40岁组、41~60岁组和＞60岁组。HUTT包括30 min的基础试验阶段和（或）20 min的药物（硝酸甘油）试验阶段。根据阳性患者血压和心电学的变化,VVS分为血管抑制型、心脏抑制型和混合型。
　　结果：HUTT阳性率为51%（624/1223例）,女性阳性率高于男性（60.1%vs 39.9%,P=0.001）。四组阳性率依次为68.3%、49.1%、48.6%和47.9%。阳性患者中混合型占51.4%(321例),血管抑制型占28.7%(179例),心脏抑制型占19.9%(124例)。HUTT阳性类型的分布受年龄因素的影响(男性：χ2=15.65, P=0.016;女性：χ2=18.84,P=0.004),性别间差异无统计学意义（P>0.05）。基础试验阶段74.8%的阳性反应出现在试验开始后22.5（17.5~27.5）min,但无年龄性别差异（P>0.05）;药物试验阶段81.9%的阳性反应出现在试验开始后7.5（5~10）min,女性发生阳性反应的时间比男性提前（7.5 min vs 10 min,P=0.004）,无年龄差异。
　　结论：HUTT诊断VVS的阳性率、阳性分型和发生阳性反应的时间存在年龄和性别差异。     

直立倾斜试验在诊断血管迷走性晕厥中的临床应用

<正>晕厥是临床常见症状之一,在普通人群中的发生率为3%,在急诊患者中约3%,住院患者中约6%。引起晕厥的原因有很多,但大多原因不明,其中,与神经反射有关的晕厥包括血管迷走性晕厥(vasovagal syncope,VVS)、颈动脉窦过敏综合征和排尿性晕厥等[1]。VVS是临床上最常见的不明原     

45例血管迷走性晕厥病人倾斜试验临床分析

目的对血管迷走神经(VS)病人的直立倾斜试验(HUT)进行临床分析.方法将45例不明原因晕厥的病人和40例健康人对照,进行基础倾斜试验(BHUT)和硝酸甘油舌下含服激发倾斜试验,观察血压、心率.结果BHUT组阳性率为13.3%,HUT加硝酸甘油含服组阳性率为51.1%,总阳性率64.4%,对照组阳性率为2.5%,晕厥组与对照组比较有统计学意义(P＜0.01).结论HUT对血管迷走神经性晕厥的诊断有较好的价值.     

Familial vasovagal syncope.

Vasovagal syncope (VVS) is a common clinical problem characterized by transient episodes of loss of consciousness due to abnormal autonomic activity. This paper describes two groups of monozygotic twins, from different families, affected by VVS and a family with several members with this condition. Their clinical characteristics, haemodynamic response to tilt, treatment, and outcome are described.     

Prognostic Value of Head‐Up Tilt Test with Intravenous Beta‐Blocker Administration in Assessing the Efficacy of Therapy in Patients with Vasovagal Syncope

Background: Although beta‐blockers are frequently used in order to prevent the recurrence of vasovagal syncope, the efficacy of this treatment is difficult to determine. Objectives: To determine if the result of a tilt test with an intravenously administered beta‐blocker can predict the long‐term efficacy of beta‐blockade. Methods: The study group consisted of 62 patients (29 females, mean age 32.8 ± 12.3 years and 33 males, mean age 35.9 ± 18.2 years) with at least two syncopal episodes during 6 months preceding the positive tilt test. After the baseline tilt test, propranolol (0.1 mg/kg BW) was administered intravenously and the tilt test was repeated. Beta‐blockade was considered effective if the subsequent tilt test proved negative (complete efficacy) or if the time until the occurrence of syncope at the subsequent tilt test was longer compared to the baseline test (partial efficacy). All the patients were put on continuous propranolol treatment and were followed up for a period of 1 year or until the time when syncope recurred. Results: Intravenously administered propranolol prevented (n = 33) or delayed (n = 18) the occurrence of syncope at the tilt test in 51 patients (82%), while it was found ineffective in the remaining 11 patients (18%). During the 8.6 ± 6.7 months (range 1–14) of the follow‐up period, the syncope recurred in 20 patients (32%), with 13 patients (25%) in the group where intravenously administered propranolol proved effective versus 7 patients (64%) for whom intravenously administered propranolol did not prevent syncope during the tilt test (P < 0.015). The survival analysis with respect to the recurrence of syncope revealed a significant correlation between the results of the tilt test with intravenously administered propranolol and the efficacy of the long‐term beta‐blocker therapy (P < 0.003). There were no significant differences with respect to the predictive value of the tilt test with propranolol between the patients showing complete and partial propranolol efficacy (ns), while significant differences were observed between these two groups on one hand and the patients in whom intravenously administered propranolol was found ineffective on the other (P < 0.04 and P < 0.002, respectively). Conclusions: Intravenous propranolol prevents tilt‐induced syncope in a significant percentage of patients. The results of the tilt tests combined with the administration of propranolol predict the efficacy of a continuous propranolol treatment. Both complete and partial propranolol efficacy at tilt test can successfully identify those patients who will benefit from continuous beta blockade.     

倾斜试验过程中血浆内皮素的变化及意义

目的 :探讨血管迷走性晕厥 (VS)患者倾斜试验过程中血浆内皮素 (ET)水平的变化及其意义。　　方法 :接受倾斜试验的 42例 VS患者基础倾斜试验阳性反应 (基础阳性组 ) 14例 ,异丙肾上腺素 (ISO)激发阳性反应(ISO阳性组 ) 2 1例 ,阴性反应 (ISO阴性组 ) 7例。11例正常健康人倾斜试验呈阴性反应 (对照组 )。在倾斜试验前 ,倾斜后5、2 0、45分及试验结束或阳性反应时采集外周静脉血 ,以放射免疫法测定血浆 ET水平。　　结果 :ISO阳性组阳性反应时血压显著下降 ,ISO阴性组血压始终稳定。试验前有晕厥史者 3组的血浆 ET水平显著高于对照组。倾斜后 5分 ,各组血浆 ET水平显著升高 (P均 <0 .0 1) ;2 0分又明显下降 (P均 <0 .0 1) ,与倾斜前相似 (P均 >0 .0 5 )。阳性反应时或试验结束时 ,各组血浆 ET水平与 45分时相似 ,但仍明显高于倾斜前。　　结论 :VS患者倾斜前基础状态下血浆 ET水平升高。倾斜后血浆 ET水平的变化与倾斜试验结果无直接关系 ,只是机体对体位改变或长时间倾斜后的一种代偿性反应。     

Determinants of Efficacy of Beta-Blocker Therapy in Patients with Asystole Induced During Head-up Tilt Testing

Background: The prognosis and treatment of patients with prolonged asystole during head-up tilt test (HUT) remain controversial. The aim of this study was to identify factors predicting a favorable outcome in patients with unexplained syncope who have an asystolic response during HUT. Methods: Passive HUT was performed at 60° for up to 45 minutes in 329 patients (162 women and 167 men, mean age 38 ± 22 years). Isoproterenol was given in escalating doses when passive HUT was negative. Asystole was defined as a ventricular pause 5 seconds. Results: Among the 173 patients with positive HUT, 21 developed syncope related to asystole (mean duration 13 ± 7.5 seconds). According to our initial experience, beta-blocker therapy was used as a first line treatment. At repeat HUT on beta blockers, 16 patients (group I) were partially (n=5) or totally (n=11) controlled by beta blockers, as opposed to 5 patients (group II) in whom asystole remained inducible. Three of them required implantation of a pacemaker and the two others refused. When compared to group I patients, group II patients were older (50 ± 9 vs 24 ± 10 years, P < 0.001) and had a longer asystole duration (22 ± 7 vs 10 ± 5 seconds, P < 0.005) during initial HUT, while spontaneous clinical manifestations were identical. The diagnostic accuracy to predict failure of beta blockers was 83% for age > 40 years, 80% for asystole > 15 seconds and 100% for both. After a follow-up of 35 ± 11 months, the two patients of group II who refused pacemaker, experienced recurrence of syncope, while the three others remained free of symptoms. Concerning group I, patients successfully managed were asymptomatic, and few episodes of recurrent presyncope were observed in only four of those partially controlled by beta blockers. Conclusions: Prolonged asystole (> 15 seconds) and an older age (> 40 years) both predict a poor response to beta-blocker therapy in patients with vasovagal syncope referred to as malignant. Satisfactory HUT under beta blockers predict a favorable clinical outcome. A.N.E. 1999;4(4):377–384     

Response to Beta Blockers in Patients with Neurocardiogenic Syncope: How to Predict Beneficial Effects

Beta-Blocker Therapy for Neurocardiogenic Syncope. No definitive data are available about the possibility of predicting improvement in patients with neurocardiogenic syncope treated with beta blockers. Among 112 patients with syncope and a positive bead-up tilt test (HUT), independent predictors for prevention of symptoms with beta blockers were determined using the Cox proportional hazards model. Each patient underwent HUT at 70° for 20 minutes both in the drug-free state and during isoproterenol infusion given to increase the heart rate by at least 25%. Fifty-nine patients bad a positive HUT during isoproterenol infusion and 53 in the drug-free state. All patients were then given esmolol infusion at 500 μg/kg per minute for 3 minutes followed by 300 μg/kg per minute maintenance dose. HUT was then repeated as previously described with or without isoproterenol, depending upon the initial positive response. Regardless of the response during esmolol, all patients were treated with metoprolol 50 to 100 mg twice daily. At follow-up, 36 patients experienced symptom relapse. Four of them bad negative HUT on esmolol, whereas the remaining 32 did not respond to the acute infusion of esmolol. Only four patients with positive HUT on esmolol had a favorable response to metoprolol. Patients responding to metoprolol were older (55 ± 12 years vs 42 ± 15 years, P < 0.05). Response to metoprolol was predicted by a negative test on esmolol (P < 0.0001) and a positive HUT on isoproterenol (P < 0.001). Age older than 42 years was also associated with a higher likelihood of metoprolol success (P < 0.02). Conclusion : Acute challenge with esmolol infusion appears to be an accurate predictor of response to chronic beta blockers, together with age and a positive HUT during low-dose isoproterenol infusion.     

直立倾斜试验联合心率变异性及核素脑血流测定对血管迷走性晕厥诊断及评估预后价值研究

特发性晕厥中以血管迷走性晕厥(VVS)最常见。目前认为VVS的发病机制与自主神经功能紊乱有关。心率变异性(HRV)是目前评估自主神经功能的重要手段。直立倾斜试验(HUTT)是目前公认的诊断VVS准金标准,本研究通过建立HUTT模