老年人倾斜试验安全性探讨

A study on the safety of tilt table test in elderly patients

目的 探讨老年人倾斜试验的安全性。 方法 785例倾斜试验中 ,6 0～ 82岁的老年患者 110例 ,平均年龄 (6 5± 4)岁 ,其中不明原因晕厥者 39例 ,心脑疾病伴晕厥者 13例 ,非晕厥者 5 8例。所有老年患者全部完成基础倾斜试验 ,异丙肾上腺素药物倾斜试验 18例。 结果 不明原因晕厥者基础倾斜试验阳性者 13例 ,其中 10例患者行异丙肾上腺素药物倾斜试验 ,阳性 6例 ;31例倾斜试验阳性病例中 ,血管减压型 5 4 8% (17/ 31) ,混合型 32 3% (10 / 31) ,心脏抑制型 12 9% (4/ 31) ,P <0 0 5。所有患者试验中均未出现任何严重不良反应 ,无 1例死亡。 结论 (1)倾斜试验对老年血管迷走性晕厥是一种安全可靠的诊断方法 ;(2 )基础倾斜试验是老年心脑疾病伴晕厥患者可供选择的鉴别血管迷走性晕厥的一种无创安全的检查手段。

Objective To study the safety of tilt table test (TTT) in elderly patients. Methods Among the 785 subjects examined for TTT, 110 were elders with an average age of( 65±4) years, ranging from 60 to 82. Out of the 110 elder subjects, 39 syncope patients were due to unknown reasons, 13 due to heart or brain diseases and 58 were non syncope subjects. We conducted base tilt table test (BTTT) in all patients and additional isoproterenol tilt table test (ITTT) in 18 patients. The BTTT protocol included 60～80 degrees upright tilt for 25 minutes and the ITTT protocol included isoproterenol infusion at 2-4 μg/min for 10 minutes. Results 13 out of 39 patients with unknown reasons had a positive BTTT and 6 out of 10 patients had a positive ITTT, respectively; Among the 31 out of 110 positive TTT patients, 17 (54.8%) showed a vasodepressor response, 4 (12.9%) a cardioinhibitory response and 10 (32.3%) mixed response. Serious abnormal responses were not observed. Conclusions (1) TTT is a safe and effective method for diagnosing the vasovagal syncope (VVS) in elderly patients; (2) Because of its safety, BTTT could be chosen for identifying the VVS in the elderly heart or brain disease patients complicated with syncope.