异丙肾上腺素后平卧位血压与血管迷走性晕厥关系的研究

目的 分析异丙肾上腺素给药后受试者平卧位心率、血压变化，探究血管迷走性晕厥（VVS）的预测指标。 方法 回顾性纳入2016年10月至2017年4月就诊于河南省人民医院内科因疑诊VVS而行二阶段法异丙肾上腺素倾斜试验（IHUTT）的患者182例。分析第一阶段阳性（阳性1组）、第二阶段阳性（阳性2组）和阴性组患者各阶段平卧位的心率、收缩压、舒张压变化，用ROC分析差异最显著的指标。 结果 IHUTT中，一阶段用药后，舒张压降幅在阳性1组和2组均显著高于阴性组 (7.6 ± 8.4 )mmHg，（5.6 ± 7.8） mmHg，（1.9± 6.9） mmHg，P<0.001)；二阶段用药后，舒张压降幅在阳性2组亦显著高于阴性组(11.8± 9.1) mmHg比（3.3± 6.3） mmHg，P<0.001]。一阶段用药后舒张压降幅的AUC为0.639(95% CI: 0.54~0.739)，ROC曲线的最佳cut-off为7.5 mmHg；二阶段用药后舒张压降幅AUC为0.778(95% CI: 0.694~0.862)，ROC曲线的最佳cut-off为6.5 mmHg。 结论 平卧位静脉滴注异丙肾上腺素后受舒张压显著降低，可作为VVS的有效预测指标。

The Relationship Between Blood Pressure in Supine Position After Isoprenaline and Vasovagal Syncope

Objective To analyze the changes in heart rate and blood pressure after isoprenaline and their efficacy in predicting vasovagal syncope(VVS). Methods A total of 182 patients who underwent a two-stage IHUTT for suspected VVS were retrospectively enrolled. According to the results of their tests, patients were divided into three groups: Stage 1 positive, Stage 2 positive, and Negative group. The changes in heart rate(HR), systolic blood pressure(SBP), and diastolic blood pressure(DBP) at each stage of the test were analyzed in each group, and the most significant differences were analyzed using the receiver operating characteristic curve (ROC). Results During IHUTT, the decrease in DBP after the first stage of drug administration was significantly higher in Stage 1 positive group and the Stage 2 positive group than in the Negative group (7.6 mmHg ± 8.4 mmHg, 5.6 mmHg ± 7.8 mmHg, 1.9 mmHg ± 6.9 mmHg, p<0.001); in the DBP drop after stage II isoprenaline administration was also significantly higher in the positive group than in the negative group (11.8 mmHg ± 9.1 mmHg, 3.3 mmHg ± 6.3 mmHg, p<0.001). The AUC of DBP drop after phase I isoprenaline administration was 0.639 (95% CI: 0.54-0.739), and the best cut point value of the ROC curve was 7.5 mmHg; the AUC of DBP drop after phase II isoprenaline administration was 0.778 (95% CI: 0.694-0.862), and the best cut point value of the ROC curve was 6.5 mmHg. Conclusion Significant reduction in DBP in?supine position after isoprenaline can be an effective predictor for VVS.