直立倾斜试验的严重反应类型及其预防和处理

Serious Reaction of Tilt Table Test and Its Prevention and Treatment

目的总结直立倾斜试验的严重反应及其预防和处理。方法试验的倾斜角度为75°,最长时间为45min。整个过程持续心电监护,建立良好的静脉通路,身体用护带保护以防意外。结果共有36例接受检查,其中20例阳性,10例出现严重反应,其中2例有颈内动脉粥样硬化,2例有慢性房颤。严重类型包括:心脏停博5s以上4例,或严重心动过缓心室率慢于50次/min达1min以上4例,或严重低血压持续1min以上2例,所有患者在发生晕厥后立即放回至平卧位,抬高下肢;心率慢者给阿托品静脉注射,有1例做了胸外按压,所有患者经处理意识很快转清,未发生并发症。结论直立倾斜试验虽为一项无创性检查,但严重反应并不少见。严格掌握适应证,术前充分准备和术中密切观察有助于避免意外的发生。

[ Objective] To conclude serious reaction of tilt table test and its prevention and treatment. [ Methods] patients were tested with a tilt angle of 75 degrees for a maximum of 45 minutes. Blood pressure was monitored during the test and patients were protected with a special bandage. [ Results] 20 of 36 cases were defined as positive including 10 with serious reaction. Two of the 10 cases had atherosclerosis, and 2 of them had chronic atrial fibrillation. Serious types include 4 cases with cardic arrest of more than 5 second, 4 with severe bradycardia for more than 1 minute and ventricular rate less than 50/min, 2 with 1 rain above sustained serious hypotension. All patients were treated by returning to supine position after syncope occurrence, intravenous atropine was given to the patients with slow heart rate, and 1 was treated by chest compressions. All patients resumed sober awareness, and no complications occurred after the treatments. [ Conclusion ] Tough tilt table test was a non-invasive examination, serious reactions accrued commonly. Strict indications, preoperative preparation and close observation will help to prevent the occurrence of accidents.