倾斜试验对血管迷走性晕厥的诊断及分型

Diagnosis and classification of vasovagal syncope induced by tilt table test

目的探讨倾斜试验对血管迷走性晕厥的诊断及分型的意义。方法８０例不明原因晕厥患者为病人组，４７例无晕厥病史的健康人作为对照组均采用此试验，包括基础倾斜试验和异丙肾倾斜试验。结果（１）不明原因晕厥患者倾斜试验阳性率（７６．２５％）明显高于对照组（２９．７９％），异丙肾滴注后，试验阳性率明显增加，假阳性率相应增加。（２）试验阳性者晕厥即刻血压与基础血压比较差异有显著性，而心率比较差异无显著性。（３）在所有试验阳性者中，血管减压型居首位（６９．３３％），其次为混合型（２６．６７％），而心脏抑制型最少（４％）。（４）在血压正常情况下，仅出现交界性加速性自主心律不会引起晕厥或晕厥先兆发生。结论倾斜试验对不明原因晕厥病人有肯定的诊断作用，并可帮助识别正常的高危人群；在血管迷走性晕厥中，血压下降是引起晕厥或先兆发生的关键环节；在分型中，以血管减压型所占比例最多；

Object To study the diagnosis and classification of vasovagal syncope(VS) induced by tilt table test (TTT).Method 80 patients with unexplained syncope and 47 healthy controls were tested,including basic tilt table test and isoproterenol tilt table test.Results (1)positive rate of TTT in unexplained syncope was obviously superior to the controls and positive rate of TTT was improved significantly after isoproterenol infusion.(2)blood pressure of TTT positive people at the instant of syncope was significantly different from their basic values,but there was no difference in heart rate.(3)in all TTT positive people,the vasodepressor type hold the first position (69.33%),then the mixed type (26.67%),the last,cardio inhibitory type (4%).(4)syncope or presyncope couldn't happen when it was AV junctional accelerated rhythm but normal blood pressure.Conclusion TTT is a quite effective diagnostic technique for unexplained syncope patient,it can also help doctor to identify healthy people susceptible to VS;In VS,blood pressure falling plays a very important role in the episode of syncope or presyncope;The vasodepressor type constitutes the majority among the three types;AV junctional accelerated rhythm can't be a positive standard.