咳嗽-晕厥综合征一例

患者，男性，75岁。2001年9月某天午餐时，因说话呛咳，持续剧烈咳嗽后突然意识丧失，约半分钟自行缓解。20天后又发生上述同样情况。清醒后无其他不适，未及时就诊。     

咳嗽晕厥综合征一例

患者 ,男 ,5 7岁。咳嗽、咳痰一周入院。无发热、心悸、胸闷、腹痛、腹泻等不适。诊断急性支气管炎。既往有高血压病十余年 ,平时血压控制在 18/ 10 k Pa左右。有矽肺史 10年 ,胸片和胸部 CT示矽肺 期。平素体健 ,无头部外伤史 ,不吸烟 ,饮酒 10 0 g/日 ,无类似剧烈咳嗽史和无晕厥发作史。体检 :血压 19/ 11k Pa,肥胖体型 ,身高 176 cm,体重 92 kg。神清 ,五官正 ,两肺呼吸音粗 ,未闻干湿罗音 ,心率 76次 / m in,律齐 ,心音强 ,各瓣膜区未闻及病理杂音 ,肝脾未扪及 ,四肢肌力正常 ,病理反射未引出。实验室检查 :三大常规、肝肾功能、心电…     

咳嗽反射性晕厥一例

<正>Charcot等于1876年首次报道咳嗽反射性晕厥(cough reflex syncope),将一阵连续性剧烈咳嗽后出现的一过性意识完全丧失称为"喉性眩晕(laryngeal vertigo)"。本病以肥胖男性居多,常患有慢性支气管炎、慢性阻塞性肺疾病或有哮喘史。患者于剧烈咳嗽后出现晕厥,意识恢复后不留后遗症。一过性意识丧失须与直立性低血压、心原性晕厥和颈动脉窦综合征鉴别,可通过明确的病史采集和检查加以区别。1病例资料患者男性,56岁,主因"发作性晕厥9年,加重7周"入     

咳嗽晕厥综合征一例

咳嗽晕厥综合征是指咳嗽时发生的短暂性意识丧失，能够迅速自行恢复而不留任何后遗症的一组病症，临床较少见。Sydenhan在1749年曾报道过类似本征的病例。1876年Charcof最早使用咳嗽晕厥综合征的名称。现将我院遇到1例报告如下。     

咳嗽性晕厥1例

患者，男，34岁，已婚，司机，住院号146334。因咳嗽11天，反复晕厥6天于2007年2月26日入院。患者入院前11天受凉后出现阵发性咳嗽，咳少许白色粘痰，伴咽痒咽痛，无畏寒发热及胸痛，无头昏头痛及乏力，服中药后症状无明显好转。6天前晨起后不久发生剧烈咳嗽，伴耳呜、面部发胀，随即意识丧失晕倒在地，头部受轻伤，持续约30S后自行清醒，     

咳嗽性晕厥1例

咳嗽是最常见的临床症状，但咳嗽导致晕厥却极少见。2005年7月我科接诊咳嗽性晕厥患者1例，因相应文献少，现将病案诊治体会报告如下，供临床商榷参考。     

咳嗽性晕厥3例报告

咳嗽性晕厥是指因剧烈咳嗽而引起短暂一过性意识丧失，临床比较少见。我科收治3例，现报告如下。 例1，患者男性，78岁。因反复咳嗽、喘息40年，加重伴咳嗽后晕厥20d入院。平素有慢性咳喘病史40余年。本次于入院前20天受凉后咳喘加重，有痰不易咳出，咳嗽剧烈时出现短暂意识丧失、四肢抽搐，约1～2min后可自行恢复清醒，无大小便失禁，无口吐白沫，无头痛、发热等伴随症状。     

支气管哮喘致咳嗽晕厥综合征1例

患者男 ,5 4岁。因反复发作性咳嗽、喘息伴晕厥 2年收入院。无吸烟史 ,无其他类型晕厥史。患者自 2年前因剧烈咳嗽后晕厥 ,并反复发作 (共 2 3次 ) ,持续时间 5～ 30秒 ,发作时面色青紫 ,呼之不应 ,站立发作时可跌倒 ,无四肢抽动或大小便失禁 ,发作后自行缓解 ,无头痛、头晕、恶心、呕吐。发作频繁时曾到当地乡镇医院行抗生素、平喘、解痉等药物静脉注射治疗 ,但疗效不佳。查体 :T36 .4℃ ,P10 5次 /m in,R2 3次 /min,Bp12 0 /75 mm Hg。体型稍胖 ,喘憋貌 ,神志清 ,端坐体位。双侧颈静脉充盈 ,颈动脉搏动正常 ,按摩颈动脉窦意识无改变。双…     

因咳嗽引起晕厥

李先生是一位事业成功人士，一家大公司的总经理，身材矮胖的他50岁不到，已经明显秃顶了。由于交际应酬的需要，李先生吸烟、饮酒都有很高的水平。人们都说吸烟、饮酒可以加速动脉硬化的发展．但李先生却并没有什么冠心病的迹象，不过近年来咳嗽则常常烦扰着他，     

晕厥后颈部皮肤剧痛一例

患者，男性，41岁。因晕厥、颈部皮肤剧痛1小时入院。患者1小时前晚间看电视时站起后突然头晕、恶心，随即跌倒不省人事，持续约1分钟意识清醒，清醒后诉颈部疼痛，疼痛性质像闪电一样。未见抽搐、呕吐，也无咬舌及二便失禁。既往体健。查体：T36．4℃，P74次／分钟，R18次／分钟，Bp110／80mmHg。发育正常，表情痛苦焦虑，神志清，查体尚合作。除颈部皮肤外其他皮肤黏膜无异常，浅表淋巴结无肿大，心、肺、腹检     

Syncope: Classification and risk stratification

BackgroundSyncope is one of the most common reasons for emergency department and urgent care clinic visits. The management of syncope continues to be a challenging problem for front-line providers inasmuch as there are a multitude of possible causes for syncope ranging from relatively benign conditions to potentially life-threatening ones. In any event, it is important to identify those syncope patients who are at immediate risk of life-threatening events; these individuals require prompt hospitalization and thorough evaluation. Conversely, it is equally important to avoid unnecessary hospitalization of low-risk patients since unneeded hospital care adds to the healthcare cost burden.ResultsHistorically, front-line providers have taken a conservative approach with admission rates as high as 30–50% among syncope patients. A number of studies evaluating both the short- and long-term risk of adverse events in patients with syncope have focused on development of risk-stratification guidelines to assist providers in making a confident and well-informed choice between hospitalization and out-patient referral. In this regard, a much needed consensus on optimal decision-making process has not been developed to date. However, knowledge from various available risk-stratification studies can be helpful.ConclusionThis review summarizes the findings of various risk-stratification studies and points out key differences between them. While, the existing risk-stratification methods cannot replace critical assessment by an experienced physician, they do provide valuable guidance. In addition, the various risk-assessment schemes highlight the need for careful initial clinical assessment of syncope patients, selective testing, and being mindful of the short- and long-term risks.     

Summer Syncope Syndrome

Background

Antihypertensive therapy is associated with significant relative risk reductions in the incidence of heart failure, myocardial infarction, and stroke. However, a common adverse reaction to antihypertensive therapy is orthostatic hypotension, dehydration, and syncope. We propose that continued use of antihypertensive medications at the same dosage during the dry summer months in patients living in the Sonoran desert leads to an increase in syncopal episodes.

Methods

All hypertensive patients who were treated with medications and admitted with International Classification of Diseases, 9th Revision code diagnosis of syncope were included. They were defined as “cases” if they presented during the summer months (May to September 2012) and “controls” if they presented during the winter months (November 2012 to March 2013). The primary outcome measure was the presence of clinical dehydration. The statistical significance was determined using the 2-sided Fisher exact test.

Results

A total of 496 patients with an International Classification of Diseases, 9th Revision code diagnosis of syncope were screened, and 179 patients were included in the final analysis. In patients taking antihypertensive medications, there were a significantly higher number of cases of syncope secondary to dehydration or orthostatic hypotension during the summer months (45%) compared with the winter months (26%) (P = .01). The incidence of syncope was significantly higher in older patients (63%) compared with younger individuals (37%) during the summer months.

Conclusions

The incidence of syncope increases during the summer months among people who reside in a dry desert climate and who are taking antihypertensive medications. On the basis of our findings, we describe an easily preventable condition that we define as the “Summer Syncope Syndrome.” We recommend judicious reduction of antihypertensive therapy in patients residing in a hot and dry climate, particularly during the summer months.     

阵发性室上性心动过速时晕厥原因的多因素分析

目的:了解阵发性室上性心动过速时发生晕厥的影响因素.方法:310例反复发作的阵发性室上性心动过速患者,其中22例既往心动过速发作时并发晕厥者为晕厥组,288例为无晕厥组.阵发性房室结折返性心动过速62例,房室折返性心动过速248例,所有患者心动过速类型由心内电生理检查确定.多因素分析其性别、年龄,心动过速时心率(次/分)、心动过速病史(年)和类型等与室上性心动过速时发生晕厥的关系.结果:晕厥组女性患者晕厥比例显著多于非晕厥组(P=0.02);房室结折返性心动过速患者比例亦显著多于非晕厥组(P=0.03).而两组间平均年龄、心动过速时的平均心率、心动过速病史均无显著性差异(P＞0.05).结论:女性及房室结折返性心动过速与晕厥相关,而患者年龄、心动过速病史、心动过速时的心率与晕厥无关.