直立倾斜试验的严重反应类型及其预防和处理

Serious responsiveness during tilt table test and its management

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４５分钟。整个过程中持续心电和血压监测，维持良好的静脉通路。身体用特殊护带保护以防意外。结果共有１８例患者接受了这一检查。其中１０例阳性，５例出现严重反应。５例中２例有颈内动脉粥样硬化，２例有慢性房颤。严重反应类型包括：心脏停搏５秒以上（２例），或严重心动过缓心室率慢于５０／ｍｉｎ达１分钟以上（２例），或严重低血压持续１分钟以上（１例）。所有患者在发生晕厥后立刻放回至平卧位，抬高下肢；心率慢者给阿托品静推。有１例做了胸外心脏按压。所有患者经处理神志很快转清，未发生并发症。结论直立倾斜试验虽然为一项无创性检查，但严重反应并不罕见。严格掌握适应证。

Objective To evaluate the serious responsiveness during tilt table test(TTT) and their management.Methods All patients were tested with a tilt angle of 75 degrees for a maximum of 45 minutes.ECG and blood pressure were monitored during the test and patients were protected with a special bandage.Results Ten of 18 patients were defined as positive including 5 having serious sreponsiveness.Two of the 5 patients had atherosclerosis involving internal carotid arteries and 2 of them had chronic atrial fibrillation.The serious sreponsiveness consisted of asystole for more than 5 seconds(2 cases) or serious bradycardia for more than 1 minute(2 cases) or serious hypotension for more than 1 minute (1 case).Those with serious responsiveness were managed with returning to supine position,introveneous atropine,and CPR (one case with asystole).All patients recovered gradually with no complication.Conclusion Although non-invasive,TTT may result in serious responsiveness.Proper patient slection,monitoring and protection are crucial for a safe outcome.