血管迷走性晕厥单中心294例结果分析

目的:对单中心33个月所做的直立倾斜试验(HUTT)结果进行分析并探讨健康教育对HUTT阳性患者再发晕厥次数的影响。方法:收集从2015年2月至2017年11月因反复晕厥或反复出现晕厥前兆在南京医科大学第一附属医院就诊并进行HUTT患者294例。根据HUTT中患者心率与血压的变化,196例HUTT呈阳性,其中混合型血管迷走神经性晕厥(Ⅰ型)146例,心脏抑制型血管迷走神经性晕厥(Ⅱ型)14例,血管抑制型迷走神经性晕厥(Ⅲ型)36例。分析各型患者HUTT阳性率并对健康教育前后HUTT阳性结果患者晕厥发生次数的差异进行比较。结果:在294例行HUTT检测的患者中,有196(66.7%)例患者出现血管迷走性晕厥,其中I型、Ⅱ型、Ⅲ型血管迷走性晕厥分别有146例(74.5%)、14例(7.1%)、36例(18.4%)。年龄>60岁患者HUTT阳性率明显高于年龄<40岁患者(77.1%vs.57.1%,P<0.01)。在196例HUTT阳性患者中,80例(40.8%)患者接受随访,随访患者接受健康教育前后,患者晕厥次数中位数从2(四分位数间距IQR:1~4)次降到0(IQR:0~0)次(P<0.001),差异有统计学意义。结论:HUTT证实,血管迷走性晕厥患者中以混合型血管迷走神经性晕厥为主,年龄较大患者HUTT阳性率较高,随访结果提示健康教育可以减少此类患者再发晕厥风险。

Results of Head-up Tilt Test in 294 Patients With Vasovagalsyncope

Objectives:We aim to analyze the results of the head-up tilt test(HUTT)performed in a single center within a period of 33 months and investigate the impact of health education on the frequency of recurrent syncope among patients with positive results of HUTT.Methods:A total of 294 patients,who underwent HUTT in the First Affiliated Hospital of Nanjing Medical University from February 2015 to November 2017 due to recurrent syncope or precursor syncope,were included in this study.Patients with positive results of the HUTT were divided into mixed type of vasovagal syncope(VVS)(typeⅠ,n=146),cardio-inhibitory type of VVS(typeⅡ,n=14)and vasodepressor type of VVS(typeⅢ,n=36)according the heart rate and blood pressure during HUTT.The frequency of recurrent syncope in patients with positive HUTT result was compared before and after the health education.Results:VVS occurred in 196(66.7%)out of 294 patients.The proportion of type Ⅰ,typeⅡand typeⅢVVS was 74.5%,7.1%and 18.4%,respectively.The positive rate of HUTT was significantly higher in age>60 years group than in age<40 years group(77.1%vs.57.1%,P<0.01).Among 196 patients with positive HUTT results,80 patients(40.8%)accepted follow-up.The median number of recurrent syncope before and after patient education in these patients were 2(IQR:1-4),and 0(IQR:0-0),respectively(P<0.001).Conclusions:Mixed type of VVS is the main kind of vasovagal syncope and the positive rate of HUTT is higher in older patients.The health education may reduce the risk of recurrent syncope among patients with positive HUTT results.