107例短暂性意识丧失患者临床特征分析

Analysi of clinical characteristic of 107 patients with transient loss of consciousness

目的分析临床特征在短暂性意识丧失(TLOC)107例患者中的初步评估价值。方法连续入选2008年1月—2012年4月收住心内科以TLOC为表现,拟诊为"晕厥待查"的患者共107例,通过一系列检查明确病因,诊断明确后对患者病因分类,再对发病时不同症状进行比较。结果 107例TLOC患者中13例患者病因不明、癫痫6例、短暂性脑缺血(TIA)4例,明确病因的84例晕厥患者分别为血管迷走性晕厥(VVS)40例、窦房结功能异常(包括快-慢综合征)9例、房室交界区功能异常5例、室上性心动过速(包括心房颤动伴激动经旁路前向传导)3例、Brugada综合征9例、长QT综合征5例、儿茶酚胺敏感性多形性室性心动过速1例、冠心病室性心律失常8例,扩张性心肌病室性心律失常3例、肥厚型心肌病室性心律失常1例。根据短期风险不同将晕厥患者分为血管迷走性晕厥(VVS)+心动过缓组与心动过速组2组,分别有54例和30例。根据详细询问患者病史,VVS+心动过缓组:抽搐3例,大小便失禁7例,恶心/呕吐16例;心动过速组:抽搐4例,大小便失禁13例,恶心/呕吐2例。其中2组间大小便失禁与恶心/呕吐发生率差异有统计学意义。结论晕厥患者出现恶心/呕吐,多发生于VVS+心动过缓组;而出现大小便失禁更多见于心动过速组,需要慎重对待。

Objective To study the preliminary evaluation value of clinical manifestation analysis in the diagnosis of transient loss of consciousness（ TLOC）. Methods A total of 107 patients with syncope of unknown originfrom January 2008 to April 2012 in the department of cardiology were enrolled into this study. TLOC was their manifestation. The cause of disease was determined through a serious of examinations. We compared these patients＇ different manifestations after classify them according to the causes of diseases. Results Among 107 cases of TLOC,there were 13 patients with unknown etiology,6 cases of epilepsy and 4 cases of transient ischemic attack（ TIA）. A total of 84 syncope patients with determined epilepsy included 40 cases of vasovagal syncope（ VVS）,9 cases of sinus node dysfunction（ include tachycardia-bradycardia syndrome）,5 cases of dysfunction of atrioventricular junction,3 cases of supraventricular tachycardia（ include the atrial fibrillation with activation conduction through forward bypass）,9 cases of Brugada Syndrome,5 cases of Long QT Syndrome,1 case of CPVT,8 cases of coronary disease with ventricular arrhythmia,3 cases of DCM with ventricular arrhythmia and 1 case of HCM with ventricular arrhythmia. We divided these syncope patients into two groups according to different short-term risks： vasovagal syncope（ VVS） combined with bradycardia group（ 54 cases） and tachycardia group（ 30cases）,respectively. According to their detailed medical history,3 cases were with convulsion,7 cases with gatism and 16 cases with nausea / vomiting in the VVS ＋ Bradycardia group,however,4 cases were with convulsion,13 cases with gatism and 2 cases with nausea / vomiting in the Tachycardia group. The incidence of gatism and nausea / vomiting between the two groups was statistically significant. Conclusion The nausea / vomiting commonly occur in patients with syncope with VVS and Bradycardia; the gatism is more common in patients with tachycardia,and they need to be managed seriously.