直立倾斜试验阳性的排尿性晕厥患者血流动力学及自主神经的反应

Reaction pattern of hemodynamics and autonomic nerves system of patients with micturition syncope in head-up tilt testing

目的:通过观察排尿性晕厥(MS)患者在直立倾斜试验中发生晕厥时心率、血压以及心率变异性(HRV)的变化,探讨MS的发病机制并对临床治疗提出新的思路。方法:对16例MS患者及20例健康者行基础直立倾斜试验和硝酸甘油诱发直立倾斜试验。试验全程行无创血压、心电监测,每3min行HRV分析。结果:16例MS患者中6例出现阳性反应,晕厥前心率达到最高,平均为(105.67±19.68)次/min,晕厥时心率比最高心率下降了(50.32±12.5)%,而SBP、DBP、MAP分别下降了(17.62±4.65)%、(16.87±6.31)%、(17.27±4.96)%。健康对照组无一例发生阳性反应。HRV分析发现,倾斜70°后,阳性反应组低频段功率标化值(LFn)和低频与高频功率标化值(HFn)的比值(LFn/HFn)均增大,HFn减小;晕厥前或结束前LFn和LFn/HFn值升至最高,HFn降至最低;晕厥时LFn与LFn/HFn急剧下降,而HFn迅速升高。健康对照组试验过程中仅有LFn与LFn/HFn的轻微变化,且与倾斜试验开始前基础状态相比差异无统计学意义。结论:MS的发生与自主神经调节功能障碍(迷走神经过度兴奋、交感神经张力不足)密切相关。在积极预防MS发作的基础上加用抗胆碱药物和自主神经调节药物,可望取得一定疗效。

Objective.The purpose of this article is to detect the pathogenesis of micturition syncope. Through the analysis of the change of heart rate （HR） ,blood pressure （BP） ,and heart rate variability （HRV） in head-up tilt testing （HUTT）,and the new therapy method against this disease was put forward. Method：Sixteen patients with micturition syncope and 20 healthy volunteers as controls were examined on Basic Head-up Tilt Testing （BHUT） as well as nitroglycerin induced head up tilt testing （NGTT）. Non traumatic BP and electrocardiogram monitoring were used during the whole process of HUTT. HRV were analyzed every 3 minutes. Result：Positive reaction （presence of signs or symptom of micturition syncope） occurred in six of 16 micturition syncope patients. The HR reached the maximum of 105.67± 19.68 bpm averaged at the point before the onset of micturition syncope. The HR during syncope dropped 50.32± 12.5% than the highest HR before the onset of syncope, while the SBP,DBP,MAP each dropped （17.62±6.32）%, （16.78±6.98）%, and（17.27±4.96）% than that the patients were tilted before. No volunteer occurred syncope in the HUTT. Through the HRV analysis, we found after tilting to 70° the normalization low frequency power （LFn） and the ratio of normalization low frequency power and normalization high frequency power （LFn/HFn） all increased, while the HFn decreased. Before the onset of syncope, the LFn and LFn/HFn increased to the maxmum and the HFn decreased to the minimum. At the point of the onset of syncope, the LFn and LFn/HFn decreased sharply while the HFn increased dramatically. The varia tion of LFn, HFn,LFn/HFn of the 20 volunteers only changed slightly. Conclusion;The pathogenic mechanism of micturition syncope is closely related with the dysfunction of the regulation of autonomic nerves system （the execssire excitation of vagus and the insufficiency of the sympathetic excitation）. Accordingly, based on the prevention of micturition syncope, if the antiparasympathetic drugs and the autonomic nerves regulator were administered, the better effects are promising.