老年人直立倾斜试验诱发晕厥的严重反应及预防

目的　观察老年患者直立倾斜试验(TTT)的严重反应，并总结其预防和处理的体会。　方法　TTT的倾斜角度为70°，基础试验最长时间为45min，多阶段异丙肾上腺素激发试验最长时间为30min。整个过程中持续心电和血压监测，维持良好的静脉通路。　结果　21例TTT阳性，其中10例出现严重反应，分别为窦性心动过缓和窦房传导阻滞3例、完全性房室传导阻滞引起心房停搏3例，严重低血压4例。所有患者在发生晕厥后立刻放至平卧位，抬高下肢；心率慢者给予阿托品静推。有2例行胸外心脏按压，4例吸氧。所有患者经处理神志很快转清，有2例经10min抢救后血压才恢复正常，但未发生并发症。　结论　TTT虽然为一项无创性检查，但严重反应并不罕见。尤其对老年人应严格掌握适应证，及时控制异丙肾上腺素滴速，密切观察心率和血压，有助于防止发生意外。

Serious responsiveness during tilt-table test in the elderly and its prophylactic management

Objective　 To summarize the onset and the management of serious responsiveness during the tilt-table test (TTT), and the prevention measures. 　Methods　Thirty-six elderly patients (26 males and 10 females, aged between 60-70) were tested with a tilt angle of 70 degrees for a maximum of 45 minutes and then processed with isoproterenol-provocative tilt testing. ECG and blood pressure were monitored during the test and the peripheral intravenous cannula were maintained for all patients with normal saline.　Results　 Twenty-one of the 36 patients were defined as positive including 10 showing serious responsiveness. Of the 10 patients, 3 had a history of atherosclerosis involving internal carotid arteries; among the 3 with bradycardia, 2 were associated with II° A-V block, and another one was with chronic atrial fibrillation. The serious reponsiveness included asystole for more than 5 seconds(3 cases) , serious bradycardia for more than 1 minute(3 cases) , and serious hypotension for more than 1 minute (4 case), respectively. Those with serious responsiveness were managed with returning to supine position, or intraveneous atropine, or CPR (2 cases), or oxygen given(4 cases). Only 2 hypotensive patients recovered gradually in 10-minute emergent management while others recovered rapidly and with no complication. 　Conclusions　 TTT may result in serious responsiveness especially in elderly patients though it is non-invasive method. Therefore, proper patient selection according to the indications, control of isoproterenal infusion and close observation of vital signs are important for a safe consequence.