晕厥的临床诊疗进展

Advancement in diagnosis and treatment of syncope

晕厥是门诊常见症状,有三个主要病因:反射性(神经介导性)晕厥、直立性低血压和心源性晕厥。反射性晕厥预后良好,而心源性晕厥有心脏猝死的高危风险。短暂意识丧失发作后,首先应根据现行晕厥的定义,与其他形式的短暂意识丧失进行鉴别后完成对晕厥的诊断,并对晕厥患者进行仔细的评估。如果初始评估明确了晕厥的病因,应行相应治疗;如果病因不明,应根据心血管事件及猝死风险进行分级及进一步评估。本综述根据晕厥的最新指南,较系统全面地对晕厥的定义、诊断检查和治疗进展进行一小结,以提高对指南的理解及实施。

Syncope is a common clinical symptom. There are three main causes of syncope：reflex（neurally mediated） syncope,orthostatic hypotension and cardiac syncope. The prognosis of patients with reflex syncope is good,whereas patients with cardiac syncope are at increased risk for sudden cardiac death. After the episode of transient loss of consciousness,according to current definition,the diagnosis of syncope should be established first,which entails differentiation from other forms of loss of consciousness. Careful evaluation of the patient with syncope is mandatory. If the underlying cause of syncope can be diagnosed during initial evaluation,the patient should be treated accordingly. If the cause of syncope remains unclear,the patient has to be stratified with respect to the risk of a cardiovascular event and sudden cardiac death and further evaluation initiated. This review gives a comprehensive summary of definition,work-up and treatment of syncope based on the current guidelines for the evaluation of syncope,so as to improve understanding and compliance of the guidelines.