倾斜试验时静滴艾司洛尔对口服美托洛尔疗效的预测研究

目的探讨血管迷走性晕厥(VVS)患者倾斜试验(HUT)时静滴艾司洛尔对口服美托洛尔疗效的预测价值.方法对首次HUT阳性的41例患者,立即进行静脉滴注短效β-受体阻滞剂艾司洛尔,再次进行HUT,不论结果如何,均口服长效β-受体阻滞剂美托洛尔,1周后重复HUT.结果在静脉滴注艾司洛尔后,31例HUT转为阴性,而10例BUT仍为阳性:口服美托洛尔,每日两次,每次25～50 mg,1周后重复HUT,31例阴性组患者中26例(83.9%)再次阴性,而5例(16.1%)HUT阳性,而阳性组10例患者中8例(80%)再次出现HUT阳性,另外2例(20%)HUT阴性.结论 VVS患者HUT静脉滴注艾司洛尔对口服美托洛尔有预测价值,此方法对筛选对β-受体阻滞剂有效的患者有帮助.

Intravenous esmolol to predict efficacy of oral metoprolol in patients with vasovagal syncope induced by head-up tilt table testing

Objective: To determine the value of intravenous esmolol to predict efficacy of oral metoprolol in patients with vasovagal syncope(VVS) induced by head-up tilt table testing(HUT).Methods: 41 patients with VVS confirmed by the first HUT were then given a continuous esmolol infusion and rechallenged with HUT, irrespective of their response to esmolol infusion, all patients had a follow-up HUT with oral metoprolol after 1 week.Results: (1) thirty-one patients had a negative HUT and ten patients had a positive HUT when given a continuous esmolol infusion. (2) Twenty-six patients(83.9%)with a negative tilt testing response during esmolol infusion had a negative tilt testing response with oral metoprolol, 5 patients(16.1%)had a positive tilt testing response. (3) Of the 10 patients with a positive tilt testing response during esmolol infusion, 8 (80%) continued to have a positive response with oral metoprolol, but 2 (20%) had a negative tilt testing response.Conclusions: It is concluded that esmolol can predict the outcome of a HUT response to oral metoprolol. This information may be helpful in formulating a therapeutic strategy at the initial HUT in patients with VVS.