直立倾斜试验阳性患者晕厥类型及其相关因素

Syncope types and correlated factors of patients with positive response in heat-up tilt testing

目的分析直立倾斜试验阳性患者晕厥类型及相关因素。方法对151例接受住院治疗的不明原因晕厥患者行基础直立倾斜试验及硝酸甘油诱发试验,观察倾斜试验过程中临床表现与血流动力学变化并进行相关性分析。结果阳性反应80例(52.9%),其中基础倾斜试验阳性14例(17.5%),硝酸甘油激发66例(82.5%);1型(混合型)45例(56.2%),2A型(心脏抑制不伴有心脏停搏)18例(22.5%),2B型(心脏抑制伴有心脏停搏)5例(6.0%)。3型(单纯血管减压)8例(10%),另外,根据血流动力学变化特点分为3组,分别是典型、不典型血管迷走神经性晕厥、直立不能耐受。其中典型阳性34例、占总阳性的42.5%,不典型46例(57.5%),直立不能耐受组13例,3组在年龄上有显著差异(P<0.01)。典型血管迷走神经性晕厥患者病史较长(平均10年),自主神经反应不良6年,直立不能耐受1年,3组在晕厥病史上有显著性差异(P<0.01)。结论倾斜试验中年轻患者多为典型的血管迷走性晕厥,较易诱发。

AIM To summarize syncope types of the patients with positive response in tilt table test and to analyze the correlated factors. METHODS One hundred and fifty-one hospitalized patients with unexplained syncope were examined using a two-stage tilt protocol with trinitroglycerin （TNG） provocation. Clinical symptoms and correlation were explored. RESULTS Eighty of the 151 （ 52. 9% ） subjects displayed positive response in heat-up tilt testing, 14（ 17.5% ）were defined as positive during baseline head-up tilt table test （BHUT） and 66（82. 5% ）were defined as positive during tilt protocol with trinitroglycerin （TNG） provocation. Forty-five cases （56. 2% ） displayed type I, 18 cases （22. 5% ） displayed type 2A of mixed vasovagal response without cardiac arrest, 5 cases （6. 0% ） displayed type 2B of mixed vasovagal response with cardiac arrest, and 8 cases （ 10% ） displayed type 3 of simple-vascular decom- pression. According to hemodynamic features, all the subjects were divided into 3 groups namely the typical vasovagal syncope, dysautonomic neuropathy and orthostatic tolerance. Among them 34 cases （42. 5% ） were typical vasovagal syncope with positive response, 46 cases （57. 5% ） dysautonomic neu- ropathy and 13 cases orthostatic tolerance, with significant age difference among the 3 groups （P 〈0. 01 ）. The case history of typical vasovagal syncope patients averaged ten years and that of autonomic neuropathy adverse reaction group was six years, while that of vertical tolerance group was less than one year, with significant difference among the three groups （P 〈 0. 01 ）. CONCLUSION Young people tend to display typical vasovagal syncope in tilt table test, which is easy to be induced. The pathogenesis remains to be explored.