131例老年性晕厥的病因分析

目的探讨老年性晕厥常见的发病病因。方法选择大连医科大学附属第二医院以晕厥待查收住院的患者252例,年龄≥60岁并符合2009年欧洲心脏病学会诊断标准的老年性晕厥患者131例,统计年龄、性别、晕厥发生时体位、诱发因素、伴随症状、意识丧失的持续时间、既往史及相关辅助检查等资料,分析各类晕厥的病因和危险因素。结果 131例老年性晕厥患者占同期全部晕厥的52.0%(131/252),神经介导性晕厥为43.5%(57例),其中血管迷走性晕厥38例,情境性晕厥15例,颈动脉窦高敏性晕厥3例,精神疾病所致晕厥1例。心源性晕厥为32.8%(43例),其中病态窦房结综合征、Ⅱ度及以上房室传导阻滞19例,阵发性室性心动过速5例,阵发性心房颤动4例,快-慢综合征1例,急性冠状动脉综合征2例,冠心病、心绞痛或心肌梗死5例,泵衰竭4例,束支传导阻滞3例。神经系统疾病所致晕厥为12.2%(16例)。其他原因晕厥为7.6%(10例)。原因不明为3.8%(5例)。二分类logistic回归分析显示,家族史、治疗依从性、糖尿病及血脂异常为神经源性晕厥、心源性晕厥患者发生的高危因素。结论老年性晕厥的主要原因为神经介导性晕厥,其次为心源性晕厥,其他原因较少见。     

老年直立不耐受患者的病因及直立倾斜试验特点分析

目的探讨老年人直立不耐受的主要病因构成和直立倾斜试验的特点。方法筛选我科门诊就诊的60岁以上初步诊断直立不耐受患者133例,排除器质性心脏病及其他疾病后,行直立倾斜试验明确诊断的患者114例,其中男性67例,女性47例,统计分析直立不耐受病因及倾斜试验的特点。结果直立不耐受患者直立倾斜试验阳性率53.5%,老年男性患者阳性率明显大于女性,差异有统计学意义(65.7%vs 36.2%,P<0.05)。在直立倾斜试验阳性患者中,主要病因为直立性低血压(67.2%),其次为血管迷走性晕厥(16.4%)和直立性高血压(16.4%)。诊断血管迷走性晕厥中,80.0%既往有至少1次晕厥发作,其中的87.5%在硝酸甘油诱发试验后出现阳性结果。诊断直立性低血压的患者中,根据低血压发生的时间,迟发性低血压(3～30min)占41.5%,其次是经典型直立性低血压(30s～3min内)占36.6%,而21.9%的患者提示为早期低血压(30s内一过性)。结论直立倾斜试验是鉴别老年直立不耐受性疾病的重要辅助检查。老年人直立不耐受的主要病因包括直立性低血压、血管迷走性晕厥和直立性高血压等。     

血管迷走性晕厥伴高血压患者的临床分析

目的分析伴高血压的血管迷走性晕厥(VVS)患者的临床特点。方法纳入出院诊断为VVS伴高血压的30例患者与单纯诊断VVS的30例患者,对比其临床特点。结果伴或不伴高血压的VVS患者的一般资料、实验室指标间差异均无统计学意义(均为P>0.05),伴高血压的VVS患者平卧位血压显著高于不伴高血压的VVS患者[平卧位收缩压:(140±21)mmHg比(113±11)mmHg;平卧位舒张压:(87±10)mmHg比(73±8)mmHg;平卧位脉压:(53±13)mmHg比(41±7)mmHg,均为P<0.05]。倾斜后两组之间血压变化差异无统计学意义(P>0.05)。在治疗方面,80%伴高血压的VVS患者需服用降压药物控制血压达到稳定状态。伴或不伴高血压的VVS患者中分别有11例(36.7%)和4例(13.3%)服用β受体阻滞剂进行治疗,差异有统计学意义(P=0.036),服或不服用β受体阻滞剂的VVS患者在年龄、性别、入院时心率、病程、晕厥发作诱因及晕厥先兆、发作次数、持续时间等方面差异均无统计学意义(均为P>0.05)。结论对伴高血压的VVS患者制定合理的降压和综合治疗方案至关重要。β受体阻滞剂作为目前治疗VVS的基本药物,其价值和特异性尚需扩大样本进一步研究。     

晕厥诊断方法新进展

<正>晕厥是指一过性全脑血液低灌注导致的短暂意识丧失,发病突然,常因伴随跌倒致伤、致残,增加死亡风险。由于病因复杂,不同病因预后差异很大,晕厥的诊断一直是极具挑战的临床问题,这也成为继续深化对晕厥病理生理机制的理解,不断开发新型诊断方法的推动力。近些年在不同类型晕厥的诊断与鉴别诊断领域取得很大进展,同时,人口老龄化使得老年人晕厥的疾病负担不断增加,由于共病、多重用药、衰弱以及记忆衰退和(或)认知功能障碍等因素的影响,老年人晕厥的诊治尤其复杂,     

直立倾斜试验对原因不明晕厥患者诊断价值及美托洛尔疗效

本研究用自制的倾斜板，对２４例原因不明晕厥患者（排除心、脑和药物等因素），进行检查。２１例诱发出症状，其中８例在基础状态下（占全组２４例的３３．３％）；１３例在用异丙肾上腺素静脉滴注时（占全组的５４．２％）。阳性反应表现为３种类型：①心脏抑制型１例；②血管抑制型２例；③混合型１８例。阳性病例给予美托洛尔５０ｍｇ，每日２次，其中６例６天后行直立倾斜试验未诱发出症状。所以，直立倾斜试验对原因不明晕厥患者的诊断是一种有效的方法。美托洛尔可用来防治直立倾斜试验诱发的晕厥。     

对拟诊血管迷走性晕厥患者进行直立倾斜试验的时程

目的 探讨直立倾斜试验的不同阶段诱导出阳性反应的合适时程.方法 回顾性分析因临床拟诊血管迷走性晕厥而进行直立倾斜试验的773例患者检查资料.直立倾斜试验分为30 min的倾斜位(70°)基础试验阶段和20 min的药物(硝酸甘油0.2 mg舌下含化)激发阶段.结果 直立倾斜试验阳性率为55.2%,其中43例(10.1%)患者阳性反应出现在基础试验阶段,384例(89.9%)出现在药物激发阶段.在基础试验阶段,阳性反应中2例(4.7%)发生在倾斜位7.5 min以后;随着时间延长,阳性反应比例逐渐增加,9例(20.9%)在22.5 min达到最高,之后逐渐下降;93%的阳性反应发生在倾斜位10～25 min内.在硝酸甘油激发阶段,阳性反应发生率在服药后迅速上升,35.7%在10 min达到最高,之后迅速下降;96.1%的阳性患者发生阳性反应在服药后的15 min内.结论 直立倾斜试验的倾斜位时间至少25 min,而药物激发阶段时间至少15 min,继续增加时间并不能明显提高阳性率.

Abstract：

Objective To investigate the time course of positive head-up tilt test (HUTT) for patients with suspected vasovagal syncope.Methods Consecutive patients referred to the syncope unit of our center for recurrent unexplained syncope were included. The HUTT consisted of a 30 minute passive basic phase and a 20 minute sublingual nitroglycerin provocation phase if syncope did not develop during the passive phase.Results Positive HUTT was observed in 427 out of 773 consecutive patients (55.2%) patients including 43 patients (10.1%) during the passive basic phase and 384 patients (89.9%) during the nitroglycerin provocation phase. During the basic phase, the positive Hutt developed at 7.5 minute (n=2) and peaked at 22.5 th minute (20.9%, n=9) and then decreased gradually. Most positive reactions (93.0%, n=40) occurred between the 10 and 25 minutes during the basic phase. During the nitroglycerin provocation phase, the percentage of positive reactions increased rapidly after sublingual nitroglycerin, peaked at the 10th minute (35.7%, n=137) and decreased thereafter. Most positive reactions (96.1%, n=369) occurred within the first 15 minutes of provocation phase.Conclusion The appropriate duration for HUTT test could be modified to a 25 minutes passive basic phase plus 15 minutes nitroglycerin provocation phase.     

直立不耐受的诊疗进展

直立不耐受是由直立位引发的一系列症状组成的综合征, 患者表现为失去维持直立状态的能力。直立不耐受可分为直立性低血压、直立性心动过速综合征、血管迷走性晕厥。有学者认为直立性高血压亦属于此范畴。直立不耐受的最大危害在于引发跌倒, 造成躯体损伤和心理问题。现对直立不耐受的诊疗进展进行综述, 期望有助于提高临床诊断的规范性和治疗的有效性。     

两种腹部加压对帕金森病患者体位性低血压变化的研究

目的探讨2种不同腹部加压对帕金森病合并体位性低血压的影响。方法选择帕金森病合并体位性低血压患者40例,采用充气式腹带分别给予20mm Hg(1mm Hg=0.133kPa)和40mm Hg腹部加压,观察腹部加压后患者体位改变前后血压变化。△收缩压=平卧位收缩压-直立位收缩压;△舒张压=平卧位舒张压-直立位舒张压。结果 20mm Hg腹部加压15s和3min△收缩压和△舒张压较干预前明显降低(P0.01);40mm Hg腹部加压15s和3min△收缩压和△舒张压较干预前明显降低(P 0.05,P 0.01)。20 mm Hg腹部加压与40mm Hg腹部加压15s和3min△收缩压与△舒张压比较,差异无统计学意义(P0.05)。患者20mm Hg腹部加压轻度不舒适28例(70.0%),中度不舒适6例(15.0%),重度不舒适6例(15.0%);40mm Hg腹部加压轻度不舒适2例(5.0%),中度不舒适15例(37.5%),重度不舒适23例(57.5%);20mm Hg腹部加压舒适度明显优于40mm Hg腹部加压,差异有统计学意义(P0.01)。结论短时间腹部加压可以有效预防直立位血压下降,对收缩压影响更为明显,2种腹部加压血压变化无明显差异,患者对20mm Hg腹部加压更为耐受。     

老年高血压患者晕厥2次

1基本病情 病史:患者男性,72岁,以"半年晕厥2次"为主诉入院.半年前行走时出现头晕,后突发意识不清,倒地,数秒后意识恢复,无大小便失禁、四肢无力、口吐白沫、视物模糊,无胸闷、胸痛、心悸,未诊治.1个月前晨起后如厕途中突发意识丧失,持续7～8 min后意识完全恢复,无大小便失禁、口吐白沫、肢体无力,无发热、畏冷、寒战...     

血管迷走神经性晕厥患者发病诱因及先兆症状分析

目的 分析血管迷走神经性晕厥患者常见晕厥诱因及先兆症状特点。方法 分析167 例接受住院治疗的不明原因晕厥患者晕厥诱因及晕厥先兆症状，并与直立倾斜试验（HUTT）结果进行相关性分析。结果 阳性反应120 例（71.8%），其中混合型占60.0%，血管抑制型占25.8%，心脏抑制型占14.2%；67.1%和93.4%不明原因晕厥患者存在晕厥诱因和先兆症状；常见的诱因有持久站立（42.9%），体位改变（21.4%），闷热环境（15.2%）等；总结了10个常见的与晕厥相关的先兆症状，其中头晕（76.6%），苍白（26.9%），乏力（52.6%），恶心或呕吐（44.9%），出汗（46.1%），感觉异常（14.9%），心悸（25.1%），黑曚（22.8%），胸闷（5.9%），听力减退（27.5%）；用Logistic回归分析发现头晕(OR:5.972,CI=2.013-17.453,P=0.001),恶心或呕吐(OR:5.774,CI=1.475-22.611，P=0.012),乏力(OR:4.048,CI=1.101-14.889,P=0.039),出汗(OR:3.36,CI=1.061-10.610,P=0.035)能够预测HUTT阳性结果。结论 详细询问晕厥患者的诱因及先兆症状，有助于我们对血管迷走神经性晕厥的诊断。     

Etiology of syncope in patients hospitalized with syncope and predictors of mortality and rehospitalization for syncope at 27-month follow-up

The authors investigated the etiologies of syncope and risk factors for mortality and rehospitalization for syncope at 27‐month follow‐up in 325 consecutive patients, mean age 66 years, hospitalized for syncope. The causes of syncope were diagnosed in 241 patients (74%). Of 325 patients, 13 (4%) were rehospitalized for syncope and 38 (12%) died. Stepwise logistic regression analysis showed that significant independent prognostic factors for rehospitalization for syncope were diabetes (odds ratio [OR], 5.7; 95% confidence interval [CI], 1.6–20.4), atrial fibrillation (OR, 4.0; 95% CI, 1.0–15.6), and smoking (OR, 4.6; 95% CI, 1.3–16.8). Stepwise Cox regression analysis showed that significant independent prognostic factors for time to mortality were diabetes (hazard ratio [HR], 2.7; 95% CI, 1.4–5.2), coronary artery bypass graft surgery (HR, 2.9; 95% CI, 1.3–6.5), malignancy history (HR, 2.5; 95% CI, 1.2–5.2), narcotics use (HR, 4.0; 95% CI, 1.7–9.8), smoking (HR, 2.8; 95% CI, 1.4–5.5), atrial fibrillation (HR, 2.4; 95% CI, 1.0–5.4), and volume depletion (HR, 2.8; 95% CI, 1.4–5.8). Copyright © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.     

心源性晕厥的病因及非侵入性诊断技术的评价

晕厥（syncope）作为临床上常见的一组症候群,其本质是脑供血骤然减少或停止而出现的短暂意识丧失,常伴有机体张力丧失而不能维持一定的体位,约占内科急诊患者的1．2％～3％,住院患者的6％。由于心源性晕厥病因复杂化、发病率高、危害性大,侵入性电生理检查在国内尚不普及,且属创伤性,因此选择和评价系列非侵入性诊断技术检出心源性晕厥具有重要的临床意义。     

Etiology,risk factors,and prognosis of patients with syncope: A single‐center analysis

ObjectiveTo investigate the main causes, risk factors, and prognosis of patients hospitalized with syncope.MethodsThe patients admitted due to syncope were included. We analyzed the etiology, risk factors, and prognosis of patients with an average follow‐up of 15.3 months.ResultsHigh‐risk factors for cardiogenic syncope included age ≥60, male, hypertension, palpitation, troponin T‐positive, abnormal ECG, CHD history, and syncope‐related trauma. Mortality rate was 4.6%, recurrence rate of syncope was 10.5%, and the rehospitalization rate was 8.5%. Univariate analysis showed that prognosis of syncope was related to age ≥60 years old, hypertension, positive troponin T, abnormal electrocardiogram, and coronary heart disease (p < .05). Multivariate Cox proportional hazard analysis showed that age ≥60 years old (p = .021) and high‐sensitivity troponin‐positive (p = .024) were strongly related to the prognosis of syncope. Kaplan–Meier curve showed statistical difference in the survival rate between the groups divided by age ≥60 years (p = .028), hs‐TnT‐positive (p < .001), abnormal ECG (p = .027), and history of CHD (p = .020).ConclusionHigh‐risk factors for cardiogenic syncope included age ≥60, male, hypertension, palpitation, troponin T‐positive, abnormal ECG, CHD family history, and syncope‐related trauma. Age, hypertension, troponin T‐positive, abnormal ECG, and CHD history were associated with the prognosis of syncope.     

Evaluating elderly patients with syncope

Age-related physiologic changes together with high prevalence of chronic illness and the use of multiple medications predispose older adults to syncope. The causes of many of these patients' syncope are unexplained and most remained symptomatic. A thoughtful diagnostic strategy is essential to pinpoint the cause in each patient. The initial assessment includes a comprehensive medical history, preferably with an eye witness account, and a thorough physical examination. The decision for further diagnostic tests often depends on whether there is evidence of underlying structural heart disease. In the absence of heart disease, tilt table testing and the related autonomic function testing are usually most productive. Various cardiac studies will be more appropriate for those with suspected structural heart disease. A cause of syncope can only be concluded if there is a sufficiently strong correlation between syncopal symptoms and the detected abnormalities on investigations. A strategic evaluation of syncope of the elderly subjects should allow a correct diagnosis and appropriate management.     

Cardiac syncope in pediatric patients

OBJECTIVE: To assess the epidemiology of cardiac syncope in children and evaluate the guidelines on its management. MATERIAL AND METHODS: We analyzed the etiology to syncope and diagnostic workup in consecutive pediatric patients presenting with syncope in our emergency departments or cardiac outpatient clinics between 1997 and 2005, and who were subsequently diagnosed as having cardiac syncope. RESULTS: A primary cardiac cause was identified in 11 syncopal patients presenting to the emergency room and 14 patients to the cardiac clinic: supraventricular tachyarrhythmia in 9, ventricular tachyarrhythmia in 10, pacemaker dysfunction in 2, and isolated cases of sick sinus syndrome, hypoxic spell, hypertrophic cardiomyopathy, and primary pulmonary hypertension. Some elements suggested potential cardiac disease as a cause of syncope in all cases. The resting electrocardiogram and the echocardiogram were interpreted as positive and relevant to the diagnosis in 17 and 3 patients, respectively. Exercise electrocardiogram and Holter recording provided diagnostic information previously not seen on the resting electrocardiogram in six and three patients, respectively. Three children have died and one child has neurological sequelae following resuscitation. CONCLUSION: Our data support the premise that careful history taking with special focus on the events leading up to syncope, as well as a complete physical examination, can guide practitioners in discerning which syncopal children need further cardiac investigations.