直立倾斜试验诱发暂时性失语14例

Fourteen cases of transient aphasia induced by head - up tilt test

目的探讨直赢倾斜试验（HUTF）过程中出现暂时性失语的临床特点及町能的发生机制。方法回顾性分析2000年9月至2014年4月在中南大学湘雅二医院晕厥专科门诊就诊或住院的不明原闲晕厥、先兆晕厥、头晕等进行HUTF患者的资料，共4401例次，年龄2～79岁，总结HUqT过程中出现暂时性失语患耆的临床特点，分析出现失语的可能机制。结果1．HUTT过程中暂时性失语发生率为3．18‰（14／4401例次），其中成人（≥18岁）发牛率7．0‰（9／1284例次），儿童（〈18岁）发牛率1．6‰（5／3117例次），二者比较差异有统计学意义（x^2=6．76，P〈0．01）。男性发生率为1．91‰（4／2091例次），女性发生率为4．33‰（10／2310例次），二者比较差异尢统计学意义（x^2=1．33，P〉0．05）。不同血流动力学类型发生率分别为血管抑制型6．05‰（10／1654例次），混合型4．18‰（2／479例次），心脏抑制型0（0／36例次），HUTT阴性0．9‰（2／2232例次），4种血流动力学类型之间发生率比较差异有统计学意义（x^2=8．22，P〈0．05），其中血管抑制型与HUTT阴性之间比较差异有统计学意义（x^2=8．18，P〈0．01）。HUTFm性者中总发生率为5．53‰（12／2169例次），与HUTT阴性者比较差异有统计学意义（x^2=6．07，P〈0．05）。2．失语出现及持续时间：失语出现于基础商立倾斜试验过程中的4～17min[（11．3±6．7）min]，或舌下含化硝酸甘油直札倾斜试验舌下含药后2—10min[（5．2±2．7）min]．失语持续时间为3min～4h，中位时间为20min。结论HUTT有诱发暂时性失语的风险，在HUTT过程中需警惕该并发症出现，尤其是受试者出现HUTT阳性反应或为成人时。

Objective To explore the clinical characteristics and the possible pathogenesis ior transient aphasia induced by head - up tilt test（ HUTr）. Methods The data of 4 401 cases（ aged from 2 to 79 years） were reviewed retrospectively with unexplained syncope,pre - syncope,or dizziness who had visited syncope specialists at out - patient department or had been hospitalized in the Second Xiangya Hospital of Central South University, and they underwent HUTF from Sep. 2000 to Apr. 2014. The clinical characteristics were summarized and the possible pathogenesis for tran- sient aphasia was analyzed. Results （ 1 ）The total incidence of aphasia was 3.18‰（ 14/4 401 cases）. The incidence in adult（ i〉18 years old） was significantly higher than that in children（ 〈 18 years old） [7.0‰（9/1 284 cases） vs 1.6‰（5/3 117 cases）,X^2 = 6.76, P 〈 0.01 ], but there was no difference between the male and female [ 1.91‰ （4/2 091 cases） vs 4.33‰（ 10/2 310 cases） ,X^2 = 1.33 ,P 〉0.05 ]. According to the hemodynamic changes,the inci- dences in vasodepressor, the mixed type, cardioinhibition and the negative response were 6.05‰ （ 10/1 654 cases）, 4. 18‰（2/479 cases）, 0 （0/36 cases） and 0. 9‰（2/2 232 cases） respectively, and the differences among the 4 groups were significant （X^2 = 8.22, P 〈 0.05 ） ; the diftbrence existed between the vasodepressor and the negative response（X^2 = 8.18,P 〈 0.01 ）. The total incidence of the positive response patients was 5.53‰（ 12/2 169 cases）, and the difference was notable compared with the negative response patients （X^2 = 6.07,P 〈 0.05 ）. （2） The onset time and the duration time of transient aphasia ： the onset time was from 4 to 17 minutes during baseline head - up tilt test, mean （ 11.3±6.7） minutes,or 2 - 10 minutes during sublingual nitroglycerin - provocated head - up tilt test,mean （5.2± 2.7 ） minutes. Aphasia duration was from 3 minutes to 4 hours, and the median time was 20 minutes. Conclusion： There is a risk of provoking transient aphasia during HUTT, which reminds that the performer should alert possible occurrence of this complication during the test,especially when the patient has a positive response,or is an adult.