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。

Analysis of predisposing causes and premonitory symptoms of vasovagal syncope

AIM To study the characteristics of predisposing causes and premonitory symptoms of vasovagal syncope. METHODS Predisposing causes and premonitory symptoms of 167 hospitalized patients with unexplained syncope were analyzed and compared with the results of heat-up tilt testing on the correlation. RESULTS One hundred and twenty (71.8%) patients had a positive result. The most common type of response was mixed type (60.0%), followed by vasodepressor (25.8%) and cardioinhibitory (14.2%) types. Totally, 67.1 % and 93.4 % of the patients with unexplained syncope had predisposing causes and premonitory symptoms. The most common predisposing causes were prolonged standing (42.9%), change of position (21.4%), and hot or warm environments (15.2%). Ten common premonitory symptoms about the vasovagal syncope were dizziness (76.6%), pale (26.9%), hypodynamia (52.6%), nausea or vomiting (44.9%), sweating (46.1%), paraesthesia (14.9%), palpitation (25.1%), amaurosis (22.8%), chest distress (5.9%), and amblyacousia (27.5%). Among patients with a positive response, dizziness (OR: 5.972, CI=2.013-17.453, P=0.001), vomiting (OR: 5.774, CI=1.475-22.611, P=0.012), hypodynamia (OR: 4.048, CI=1.101-14.889, P=0.039), and sweating (OR: 3.36, CI=1.061-10.610, P=0.035) could predict the positive result of HUTT. CONCLUSION Detailed inquiry about predisposing causes and premonitory symptoms is of great help in correct diagnosis of vasovagal syncope.