异丙肾上腺素诱发倾斜试验对饮酒性血管迷走性晕厥的诊断

对饮酒后发生晕厥的12例患者先后进行基础倾斜试验、硝酸甘油和异丙肾上腺素诱发的倾斜试验。结果:基础倾斜试验全部阴性,硝酸甘油诱发阳性2例,异丙肾上腺素诱发阳性11例。结论:异丙肾上腺素诱发倾斜试验对饮酒性血管迷走性晕厥的阳性病例多。     

硝酸甘油与异丙肾上腺素直立倾斜试验诊断血管迷走性晕厥对比研究

目的:比较舌下含服硝酸甘油与静脉泵入异丙肾上腺素直立倾斜试验诊断血管迷走性晕厥的价值。方法:回顾性分析我院行直立倾斜试验的326例患者。其中行基础加舌下含服硝酸甘油直立倾斜试验129例(硝酸甘油组),行基础加静脉泵入异丙肾上腺素直立倾斜试验197例(异丙肾上腺素组),比较两种药物直立倾斜试验阳性率、诱发阳性反应时间、血压心率变化和不良反应。结果:硝酸甘油组阳性率高于异丙肾上腺素组(46．9％vs 30．7％,P<0．01)。硝酸甘油组诱发阳性反应时间(7．8±3．6)分钟高于异丙肾上腺素组(5．6±1．5)分钟,但无显著差异(P>0．05),而总试验时间硝酸甘油组明显短于异丙肾上腺素组[(37．8±3．6)分钟vs(72．6±7．3)分钟,P<0．01]。硝酸甘油组不良反应发生率较异丙肾上腺素组低(0．9％vs 11．7％,P<0．01)。结论:硝酸甘油直立倾斜试验有较高的阳性率,操作方便,完成试验时间短,不良反应少。     

硝酸甘油激发试验对诊断老年人血管迷走性晕厥的安全性和可行性研究

血管迷走性晕厥(vasovagal syncope,VVS)是不明原因晕厥中最常见的一种,其发病机制、诊断和治疗一直是临床关注的热点之一.直立倾斜试验(head-up tilt test,HUTT)是目前诊断VVS的准金标准,现临床上多采用静脉滴注异丙肾上腺素进行药物激发倾斜试验的方法.虽然该方法能提高诊断的阳性率,但操作繁琐,患者耐受性差,而且老年人由于心血管疾病患病率高,异丙肾上腺素的使用可能会引发严重的不良反应.我们采用硝酸甘油替代异丙肾上腺素对老年VVS患者行HUTT检查,探讨其安全性和有效性.     

老年原发性高血压患者伴血管迷走性晕厥的相关研究

目的观察直立倾斜试验(HUTT)对老年原发性高血压患者伴血管迷走性晕厥(VVS)阳性诊断情况。方法选择2017年9月～2019年9月于我院住院或门诊诊治的老年原发性高血压疑似VVS患者40例为高血压组,选择同期因晕厥或头晕、黑矇等症状就诊的临床无器质性疾病患者50例为对照组,2组均进行HUTT,包括基础倾斜试验(BTTT)和硝酸甘油倾斜试验(NTTT),记录HUTT阳性率,在HUTT前后检测血浆肾上腺素水平。结果高血压组与对照组HUTT阳性率比较,无显著差异(47.5%vs 54.0%,P=0.540),但高血压组BTTT阳性率显著高于对照组(30.0%vs 10.0%,P=0.016);NTTT阳性率显著低于对照组(17.5%vs 44.0%,P=0.043);HUTT阳性患者中,高血压组试验前肾上腺素水平显著高于对照组(P=0.000),2组试验后较试验前肾上腺素水平均显著升高(P=0.004,P=0.000),对照组试验后肾上腺素水平较高血压组明显升高(P=0.006)。结论部分老年原发性高血压患者出现的晕厥症状是由VVS所致,血浆肾上腺素在VVS发生过程中显著升高。     

舌下含服硝酸甘油和静脉滴注异丙肾上腺素试验对血管迷走性晕厥诊断及分型的影响

为探讨舌下含服硝酸甘油和静脉滴注异丙肾上腺素激发试验对血管迷走性晕厥 (VVS)的影响。对 190例病人分成三组进行了试验。结果舌下含服硝酸甘油能提高 6 0 .4 6 %的VVS阳性率 ;静脉滴注异丙肾上腺素能提高 51.2 5%的VVS阳性率 ,尤其增加了血管抑制型晕厥病人的比例。硝酸甘油激发试验阴性的患者异丙肾上腺素激发试验可以阳性 ,反之亦然     

倾斜试验中血管抑制型诊断方法的探讨

目的探究硝酸甘油诱发倾斜试验血管抑制型阳性反应患者病因诊断方法。方法将2018年9月至2019年7月在我科行硝酸甘油诱发倾斜试验并出现血管抑制型阳性反应的患者70例纳入本次研究,探讨能否通过卧立试验、硝酸甘油卧立试验及异丙肾上腺素诱发倾斜试验这三种诊断方法进一步鉴别及明确诊断,避免漏诊和误诊,以提高倾斜试验诊断的准确性。结果 40例为血管抑制型血管迷走神经性晕厥,4例为体位性低血压晕厥,6例为体位性低血压晕厥合并血管抑制型迷走神经性晕厥,6例为硝酸甘油所致体位性低血压晕厥,14例为硝酸甘油所致体位性低血压晕厥合并血管抑制型迷走神经性晕厥。结论每一个可疑血管迷走神经性晕厥需要行倾斜试验的患者,可先行卧立位试验及硝酸甘油卧立试验排除体位性低血压晕厥及硝酸甘油所致体位性低血压晕厥后再行基础加硝酸甘油诱发倾斜试验,避免漏诊或误诊,使患者得到有效的针对性治疗,降低医疗费用,具有较高的社会、经济效益。     

腺苷倾斜试验对血管迷走性晕厥诊断价值探讨

目的探讨腺苷在直立倾斜试验中的诊断价值.方法70例不明原因晕厥者进行直立倾斜试验(TTT)和药物激发倾斜试验.激发药物为腺苷和异丙肾上腺素,试验全程行多导心电图及血压监护.结果TTT诱发晕厥32例,阳性率为45.7%(32/70);37例异丙肾上腺素倾斜试验诱发晕厥12例,阳性率为32.4%(12/37),其中2μg/min诱发7例,5μg/min诱发5例;腺苷倾斜试验28例,诱发晕厥17例,阳性率为60.1%,其中6mg诱发晕厥7例,12mg诱发晕厥10例.结论腺苷对血管迷走性晕厥有较好的诊断价值.     

倾斜试验阳性的原因不明晕厥年轻患者使用美托洛尔的价值

13±3(8～20)岁的21(男7、女14)例患者至少有一次原因不明的晕厥,且倾斜试验阳性即能诱发晕厥或先兆晕厥。初次倾斜试验,A组14例在基础状态下诱发晕厥(7例)或先兆晕厥(7例)B组7例在静脉给予异丙肾上腺素(0.03～0.1μg/kg/min)时诱发晕厥(3例)或先兆晕厥(4例)。1例表现为心脏抑制(心率减慢≥20％或症状开始时心脏停搏≥     

异丙肾上腺素消心痛激发倾斜试验对比分析

目的对比分析异丙肾上腺素、消心痛激发倾斜试验的敏感性、特异性、耐受性、安全性的差异。方法选择2001年12月至2006年9月于甘肃省金昌市第二医院就诊并符合条件的33例有晕厥发作史的患者及15例无晕厥史者行基础倾斜试验(BTTT),BTTT阴性者连续2d随机进行异丙肾上腺素倾斜试验(ITTT)和消心痛倾斜试验(GTTT)。结果消心痛组敏感性为65.2%,特异性为93.3%,耐受性较好。异丙肾上腺素组敏感性为69.6%,特异性为86.7%,耐受性较差。结论消心痛倾斜试验与异丙肾上腺素倾斜试验比较敏感性、特异性无明显差异,耐受性、安全性好。     

倾斜试验加异丙肾上腺素静滴用于血管迷走神经性晕厥的诊断

本文研究倾斜体位加异丙肾上腺素静滴诱发血管迷走神经性晕厥,12例有晕厥史的病人中9例诱发出晕厥,而6例正常人无1例阳性.晕厥发作时伴有血压明显下降;试验结束时,阳性组和对照组收缩压比较为10±1.2kPa(75±9mmHg)vs13.3±0.65kPa(100±5mmHg)(P<.001),舒张压力5.3±1.3kPa(40±10mmHg)vs8.3±0.4kPa(62±3mmHg)(P<0.001),阴性组和对照组相比无差异;晕厥发生在倾斜后7±3.2分钟,晕厥时血压处于最低点即收缩压由倾斜开始时的14.9±1.9kPa(112±14mmHg)降到10±1.2kPa(75±9mmHg)(P<0.001),舒张压由10±1,2kPa(72±9mmHg)降至5.3±1.3kPa(40±10mmHg)(P<0.001);阳性组中有2例低血压同时伴心动过缓.倾斜体位加异丙肾上腺素静滴方法用于诊断血管迷走神经性晕厥简单、安全、且为非创伤性手段,对临床诊治有一定帮助.     

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.     

Specificity and total positive rate of head-up tilt testing potentiated with sublingual nitroglycerin in older patients with unexplained syncope

The aim of this study was to assess the specificity and total positive rate of head-up tilt testing (HUTT) potentiated with sublingual nitroglycerin in detecting the vasovagal origin of unexplained syncope in the elderly, since the diagnostic value of this non-invasive test has not yet been proven in this age group. In a period of 3 years, 128 elderly patients (mean age 71.6+/-5.1 years, 50% males) with syncope of unknown origin, and 101 control subjects matched for age and gender were tilted upright to 60 degrees for 45 minutes. If syncope did not occur, sublingual nitroglycerin (0.4 mg) was administered, and observation was continued for 20 minutes. The positive response was defined as the reproduction of syncope or pre-syncope according to VASIS definition. During the unmedicated phase, syncope occurred in 26 patients (20.3%) and in no members of the control group. After nitroglycerin, 53 patients (41.4%) and 2 control subjects (2%) displayed syncope. The total positive rate of the test was 61.8% with a specificity of 98.0%. In conclusion, HUTT potentiated with sublingual nitroglycerin provides an adequate specificity and total positive rate in old patients with unexplained syncope; therefore it can be proposed as a useful diagnostic tool to detect the vasovagal origin of syncope not only in middle but also in advanced age.     

舌下含化硝酸甘油倾斜试验对血管迷走性晕厥的诊断价值

目的 探讨舌下含化硝酸甘油倾斜试验对诊断血管迷走性晕厥（VS）的价值。方法 42例血管迷走性晕厥病人（VS组）及20例无晕厥史健康人（对照组）先行基础倾斜试验（BTTT），阴性者再做舌下含化硝酸甘油倾斜试验（SNTTT）。结果 BTTT阳性诱发率VS组为24％（10／42）对照组为0；两组病人无1例发生体位性低血压。VS组和对照组SNTTT阳性诱发率分别为47％（15／32）、10％（2／20），药物诱发体位性低血压发生率分别为12．5％、10％，两组病人仅有1例出现头痛，但能坚持试验。结论 SNTTT对VS具有较高的敏感性和特异性，副作用小，操作简便省时，是一实用的检查技术。     

Comparison of diagnostic accuracy of sublingual nitroglycerin test and low-dose isoproterenol test in patients with unexplained syncope

Despite the widespread use of head-up tilt testing as a means for diagnosing vasovagal syncope, standardization of test methodology remains a controversial issue. The aim of this study was to compare the diagnostic value of head-up tilt testing potentiated with sublingual nitroglycerin with that of head-up tilt testing potentiated with low-dose isoproterenol. For this purpose, 71 patients with unexplained syncope (mean age 43 years) and 30 asymptomatic controls were studied. All underwent the sublingual nitroglycerin and low-dose isoproterenol tests on separate days in a randomized fashion. The protocol of the 2 tests was similar and consisted of 2 phases. Initially, subjects were tilted at 60 degrees for 20 minutes without medication; then, if syncope did not occur, patients and controls received sublingual nitroglycerin (300 microg) or low-dose intravenous isoproterenol (mean infusion rate 1.3 +/- 0.5 microg/min) and continued to be tilted at 60 degrees for a further 20 minutes. During the sublingual nitroglycerin test, a positive response (syncope associated with sudden hypotension and bradycardia) occurred in 35 patients (49%), a negative response in 36 (51%), and drug intolerance in none (0%). During the low-dose isoproterenol test, these percentages were 41%, 59%, and 6%, respectively. A concordant response was observed in 53 cases (75%). Among controls, 3 subjects (10%) had a positive response to the sublingual nitroglycerin test and 4 (13%) to the low-dose isoproterenol test. It is concluded that sublingual nitroglycerin and low-dose isoproterenol are equivalent tests for evaluating patients with unexplained syncope. The sublingual nitroglycerin test, however, is simpler, better tolerated, and safer than the low-dose isoproterenol test and, thus, more suitable for routine clinical use.     

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...     

闭环刺激双腔起搏器防治血管迷走神经性晕厥的疗效观察

目的:观察植入闭环刺激双腔起搏器防治血管迷走神经性晕厥（VVS）的效果。方法: 将40例经直立倾斜试验确诊为VVS且近期多次发作的患者,分为起搏器组（18例）和药物治疗组（22例）,所有患者均给予口服美托洛尔缓释片（475 mg,1次/d）,起搏器组植入具有闭环刺激功能（CLS）的双腔起搏器,药物治疗组不做其他治疗,两组患者治疗3个月后复查直立倾斜试验并随访观察。结果: 起搏器组直立倾斜试验转阴率94%,药物治疗组直立倾斜试验转阴率29%,两组比较差异有统计学意义（P<001）。两组患者随访观察6～21(13±5)个月,起搏器组所有患者均未再发晕厥,2例有晕厥先兆,但症状较前明显减轻;药物治疗组9例再发晕厥,但发作次数较前减少。两组患者间晕厥复发率差异有统计学意义（P<001）。结论: 具有闭环刺激功能双腔起搏器能有效的防治血管迷走神经性晕厥。     

Heart rate variability in neurally mediated reflex syncope

OBJECTIVE: The aim of this study was to investigate the heart rate variability (HRV) parameters in patients with neurally mediated reflex syncope. METHODS: Thirty-three patients (10 men, age range 16-50 years) who were scheduled to undergo head-upright tilt test (HUTT) with a typical history of vasovagal syncope (VVS) underwent 24-hour Holter monitoring in an attempt to study HRV parameters. Sixteen individuals without syncope and similar baseline characteristics made up the control group. RESULTS: Seventeen of the 33 syncopal patients showed HUTT positivity. All the time domain HRV parameters except the mean RR interval were higher in the HUTT (+) syncopal patients than in the negative responders. Although not statistically significant, the positive responders had higher NN50, pNN50, RMSSD and SDNNi values than the control group. HUTT (-) VVS patients had lower SDNN and SDANN values when compared with the control group.The other HRV parameters did not differ significantly between the HUTT (-) patients and the control group. CONCLUSION: Increased parasympathetic tonus as reflected by significantly higher HRV parameters is associated with a greater frequency of HUTT positivity in patients with syncope and no organic heart disease.     

心率减速力及心率变异性对中老年血管迷走性晕厥患者的诊断价值

目的 评价心率减速力（deceleration capacity,DC）和心率变异性（heart rate variability,HRV）对中老年血管迷走性晕厥（vasovagal syncope,VVS）患者的诊断价值。 方法 对57例不明原因晕厥的中老年患者进行直立倾斜试验（HUTT）及动态心电图监测,根据结果将研究对象分为HUTT阳性组（25例）和HUTT阴性组（32例）。分析两组DC和HRV各指标的差异。绘制ROC曲线,分析DC和HRV对中老年VVS患者的诊断价值。 结果 HUTT阳性组DC和HRV各指标均高于阴性组,其中DC、SDNNi、rMSSD、LF显著增高,差异有统计学意义（P<0.05）。ROC曲线分析结果显示,DC和LF对VVS的检出存在预测价值,最佳的临界值分别为6.6 ms、340 Hz。 结论 中老年VVS患者在无症状期间自主神经功能紊乱。DC和LF适用于临床筛查中老年VVS患者。     

Reproducibility of head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope.

Head-up tilt testing (HUTT) potentiated with sublingual nitroglycerin has gained acceptance as means of diagnosing neurally mediated syncope. To evaluate the reproducibility of HUTT potentiated with sublingual nitroglycerin, 48 patients with unexplained syncope prospectively underwent 2 consecutive tests 1 to 28 days apart. The initial test ended in syncope in 34 patients (71%). In 9 patients (19%) the test was positive during the drug-free phase, whereas 25 patients (52%) had syncope after nitroglycerin administration. Of these 34 patients with an initial positive test result, 27 (79%) had a reproducible outcome on repeat testing. Of 12 patients (25%) with an initial negative test result, 10 (83%) had a reproducible outcome on repeat testing. Of 2 patients (4%) with a first test ending in exaggerated response, both had a negative repeat test response. The overall reproducibility of sublingual nitroglycerin tilt-table testing was 77%. In a group of 23 patients with both positive tests, 19 (83%) had the same response modality (2 vasodepressor, 4 cardioinhibitory, 13 mixed response). In the same group of patients, individual trough heart rates correlated well with each other between tests. Finally, in the 27 patients with both positive tests, intrapatient time of onset of symptoms did not significantly correlate between tests. Thus, in patients with syncope of unknown origin, HUTT potentiated with sublingual nitroglycerin provides an adequate reproducibility when repeated on different days.     

Correlation between results of head-up tilt test and clinical features in patients with syncope or presyncope

Background

Head-up tilt test (HUTT) is a well-established diagnostic tool in patients with suspected vasovagal syncope. Identification of factors that predict a positive HUTT result could simplify diagnostic steps. The aim of this study was to assess the correlation between clinical characteristics of patients with suspected neurocardiogenic syncope or presyncope and results of HUTT.

Materials and Methods

The study group consisted of 90 patients (55 men, 35 women; mean age, 43.2 ± 17 years) with a history of syncope or presyncope. Cardiological and neurologic test findings were normal in every patient. The patients were tilted to a 70° position for 45 minutes. If the first phase produced a negative response, the patients received 400 μg of sublingual nitroglycerin for the second phase and continued to be tilted for an additional 15 minutes.

Results

Sixty-four patients had a positive HUTT result, characterized by a vasodepressive response in 26 patients, mixed response in 24 patients, and cardioinhibitory response in 14 patients. In logistic regression analysis, the presence of prodromal symptoms was a predictor of a positive HUTT result (P = .002).

Conclusion

We showed that the prognostic performance of clinical features, including the time interval between the last episode and HUTT, the number of syncope or presyncope episodes, age, and sex, was not ideal. The presence of prodromal symptoms might be more likely to predict a positive response during HUTT.