直立倾斜试验阳性反应出现后的心律失常特征

目的 探讨直立倾斜试验(HUTT)阳性反应出现后患者心律失常发生的特征.方法 分析2001年3月至2009年8月在基础直立倾斜试验(BHUT)或舌下含化硝酸甘油倾斜试验(SNHUT)阳性反应出现后发生心律失常的169例患者资料,男性57例,女性112例,年龄6～65(23.1±14.8)岁,儿童(<18岁)86例,成人(≥18岁)83例.结果 心律失常发生在BHUT和SNHUT阳性反应后的患者分别为75例(44.38%)、94例(55.62%).常见类型为窦性心动过缓(143例,84.62%)、交界性逸搏心律(55例,32.54%)、窦性停搏(26例,15.38%),其中窦性心动过缓在成人更多见(P<0.01),窦性停搏和交界性逸搏心律的发生无年龄、性别和试验方式差别;心律失常与晕厥或接近晕厥的临床表现几乎同时出现者为77例(45.56%)、滞后出现者92例(54.44%),并且前者多发生在BHUT中,后者多发生在SNHUT中(P<0.05);心律失常与血压下降几乎同时出现者为84例(53.50%),滞后出现者73例(46.50%),且前者多发生在BHUT中,后者多发生在SNHUT中(P<0.01).结论 (1)HUTT阳性反应发生后常见心律失常为窦性心动过缓、交界性逸搏心律和窦性停搏,窦性停搏的发生无年龄、性别和试验方式的差别,试验操作中需提高警惕;(2)BHUT中,心律失常多与晕厥或接近晕厥的表现、血压的下降同时发生;SNHUT中,心律失常多发生于晕厥或接近晕厥的表现和血压下降之后,可能与硝酸甘油药理作用有关.

Arrhythmia after a positive head-up tilt table test

Objective To study the characteristics of arrhythmia after a positive head-up tilt table test (HUTT). Methods Head-up tilt table test (BHUT) or sublingual nitroglycerin-provocation head-up tilt table test (SNHUT) were performed in 1374 patients at the Second Xiangya Hospital of Central South University from March of 2001 to August of 2009. Arrhythmias were recorded in 169 patients after a positive HUTT 57 male, age 6 - 65 years, 86 children < 18 years, mean age (23. 1 ± 14. 8) years]. Results Arrhythmias developed in 75 patients (44.38%) post a positive BHUT and in 94 patients (55.62%) post a positive SNHUT. Major types of arrhythmias were sinus bradycardia ( 143/169, 84. 62% ), junctional escape rhythm (55/169, 32.54%) and sinus arrest (26/169, 15. 38% ). Sinus bradycardia was more common in adult (P < 0. 01 ). Occurrence of junctional escape rhythm and sinus arrest was not affected by age, gender and test mode. Arrhythmia and the manifestation of syncope or pre-syncope occurred simultaneously in 77 (45.56%) patients and mainly in BHUT, while arrhythmia appeared later than the syncope manifestation in 92 (54.44%) patients and mainly in SNHUT (P <0. 05). Arrhythmia and blood pressure reduction occurred simultaneously in 84 (53.50%) cases and mainly in BHUT, while arrhythmia appeared later than reduction of blood pressure in 73 (46. 50% ) cases and mainly in SNHUT (P<0. 01 ).Conclusions ( 1 ) The common types of arrhythmia were sinus bradycardia, junctional escape rhythm and sinus arrest after a positive HUTT. Occurrence of sinus arrest was not affected by age, gender and test mode. (2)In BHUT, arrhythmia occurred mostly simultaneously with the manifestation of syncope or presyncope and blood pressure reduction, while arrhythmia appeared later in SNHUT.