老年直立不耐受患者的病因及直立倾斜试验特点分析

Etiology of orthostatic intolerance and characteristics of head-up tilt test in elderly subjects

目的探讨老年人直立不耐受的主要病因构成和直立倾斜试验的特点。方法筛选我科门诊就诊的60岁以上初步诊断直立不耐受患者133例,排除器质性心脏病及其他疾病后,行直立倾斜试验明确诊断的患者114例,其中男性67例,女性47例,统计分析直立不耐受病因及倾斜试验的特点。结果直立不耐受患者直立倾斜试验阳性率53.5%,老年男性患者阳性率明显大于女性,差异有统计学意义(65.7%vs 36.2%,P<0.05)。在直立倾斜试验阳性患者中,主要病因为直立性低血压(67.2%),其次为血管迷走性晕厥(16.4%)和直立性高血压(16.4%)。诊断血管迷走性晕厥中,80.0%既往有至少1次晕厥发作,其中的87.5%在硝酸甘油诱发试验后出现阳性结果。诊断直立性低血压的患者中,根据低血压发生的时间,迟发性低血压(3～30min)占41.5%,其次是经典型直立性低血压(30s～3min内)占36.6%,而21.9%的患者提示为早期低血压(30s内一过性)。结论直立倾斜试验是鉴别老年直立不耐受性疾病的重要辅助检查。老年人直立不耐受的主要病因包括直立性低血压、血管迷走性晕厥和直立性高血压等。

Objective To study the major causes of orthostatic intolerance and the characteristics of head-up tilt （HUT） test in elderly subjects. Methods One hundred and thirty-three orthostatic intolerance patients aged over 60 years and 114 patients without organic heart disease and other diseases （67 males and 47 females） were included in this study. The causes of orthostatic intolerance and characteristics of HUT test were analyzed. Results The positive rate of HUT test was 53.5% in the orthostatic intolerance patients and significantly higher in elderly males than in elderly females （65.7% vs 36.2%, P d0.05）. Orthostatic hypotension （67.2%） ,vasovagal syncope （16.4%） and orthostatic hypertension （16.4%） were the major causes of orthostatic intolerance in elderly subjects. Of the patients with vasovagal syncope,80.0% had a previous attack of syncope at least,87.5% were positive in nitroglycerin provocation test. Of the patients with orthostatic hypotension,41.5% were diagnosed with delayed hypotension （3-30 min）,36.6% were diagnosed with classic orthostatic hypotension （30 s-3 min）,and 21.9% were diagnosed with inital hypotension （30 s-transient）. Conclusion HUT test is an important accessory examination to identify the causes of orthostatic intolerance in elderly subjects. Orthostatic hypotension,vasovagal syncope and orthostatic hypertension are the major causes of orthostatic intolerance in eldly subjects.