倾斜试验合并舌下含化硝酸异山梨酯对血管迷走性晕厥的诊断价值

目的：探讨直立倾斜试验（HUTSI）合并舌下含化硝酸异山梨酯对血管迷走性晕厥（VVS）的诊断价值。方法：52例vvs患者（VvS组）及38例无晕厥病史的健康体检者（正常对照组）先进行基础直立倾斜试验（BHUT），阴性者再进行HUTSI试验。结果：BHUT阳性诱发率VVs组为25％（13／52）而正常对照组为0；阳性者由平卧位至HUT阳性时心率及平均动脉压均明显下降（73．1±8．5）次／min比（56．2±11．2）次／min，（81．2±10．8）mmHg比（50．2±10．4）mmHg，P均〈0．053。VVS组剩余39例进行HUTSI试验，阳性者21例，阳性诱发率为53．9％而正常对照组为5．3％（2／38），HUTSI阳性者由平卧位至HUT阳性时心率及平均动脉压也明显下降（65．2±7．5）次／min比（52．9±10．5）次／min，（78．3±10．7）mmHg比（48．8±11．2）mmHg，P〈0．01，〈0．053。HUTSI阳性组从倾斜开始至出现阳性反应的时间比BHUT阳性组明显缩短（10．8±9．3）min比（21．1±11．5）min，P〈0．05]。VVS组仅2例而正常对照组仅1例出现头痛、面红等副作用，但均能坚持试验。结论：直立倾斜试验合并舌下含化硝酸异山梨酯诊断血管迷走性晕厥，敏感性好，特异性高，而且简便省时，副作用少，是一项实用的检查技术。

Diagnostic value of head-up tilt test with sublingual isosorbide dinitrate in patients with vasovagal syncope

Objective： To explore the diagnostic value of head-up tilt test with sublingual isosorbide dinitrate （HUTSI） in patients with vasovagal syncope （VVS）. Methods： A total of fifty-two consecutive patients with clinically vasova- gal syncope （VVS group） and thirty-eight control subjects without prior experience of syncope （normal control group） were evaluated by baseline head-up tilt table test （BHUT）, then the BHUT negative subjects underwent HUTSI test. Results： （1） Positive BHUT test rate of VVS group and normal control group were 25% （13/52） and 0 respectively; from supine to HUT positive, there were significant decrease in heart rate （73. ± 8.5） times/min vs. （56.2±11. 2） times/mini and mean arterial pressure MAP, （81.2±10.8） mmHg vs. （50.2±10.4） mmHg, P〈0.05 both] in BHUT positive subjects. There were 21 HUTSI positive cases （53.9%） among the other 39 VVS pa- tients, and two cases （5.3%） among the 38 subjects of normal control group. From supine to HUTSI positive, there were significant decrease in heart rate （65.2 ± 7.5） times/min vs. （52.9 ± 10.5） times/mini and MAP （78. 3±10.7） mmHg vs. （48.8±11.2） mmHg, P〈0.05 both] in HUTSI positive subjects. Duration from tilt started to positive reaction occurred in HUTSI positive group was significantly shorter than that of BHUT positive group （10.8±9.3） min vs. （21.1±11.5） rain, P〈0.05]. All subjects can tolerate the test and only two cases in VVS group and one case in normal control group occurred headache and face red. Conclusion.. Head-up tilt test with sublingual isosorbide dinitrate is a practical and easy-to-perform method with high sensitivity, specificity and few side effects for diagnosis of vasovagal syncope.