131例老年性晕厥的病因分析

Etiology of syncope in 131 elderly patients

目的探讨老年性晕厥常见的发病病因。方法选择大连医科大学附属第二医院以晕厥待查收住院的患者252例,年龄≥60岁并符合2009年欧洲心脏病学会诊断标准的老年性晕厥患者131例,统计年龄、性别、晕厥发生时体位、诱发因素、伴随症状、意识丧失的持续时间、既往史及相关辅助检查等资料,分析各类晕厥的病因和危险因素。结果 131例老年性晕厥患者占同期全部晕厥的52.0%(131/252),神经介导性晕厥为43.5%(57例),其中血管迷走性晕厥38例,情境性晕厥15例,颈动脉窦高敏性晕厥3例,精神疾病所致晕厥1例。心源性晕厥为32.8%(43例),其中病态窦房结综合征、Ⅱ度及以上房室传导阻滞19例,阵发性室性心动过速5例,阵发性心房颤动4例,快-慢综合征1例,急性冠状动脉综合征2例,冠心病、心绞痛或心肌梗死5例,泵衰竭4例,束支传导阻滞3例。神经系统疾病所致晕厥为12.2%(16例)。其他原因晕厥为7.6%(10例)。原因不明为3.8%(5例)。二分类logistic回归分析显示,家族史、治疗依从性、糖尿病及血脂异常为神经源性晕厥、心源性晕厥患者发生的高危因素。结论老年性晕厥的主要原因为神经介导性晕厥,其次为心源性晕厥,其他原因较少见。

Objective To study the etiology of syncope in elderly patients.Methods One hundred and thirty-one elderly syncope patients aged ≥ 60 years were included in this study.Their age,gender,syncope occuring position,inducing factors,accompany symptoms,consciousness loss duration,past illness history and related accessory examination parameters were recorded.The etiology of and risk factors for syncope were anayzed.Results The 131 elderly syncope patients accounted for 52.0% of the 252 syncope patients admitted to our hospital in the same period.Of the57（43.5%）nerve-mediated syncope patients,38 were diagnosed with vasovagal syncope,15 with situational syncope,3 with sinus hypersensitivity syncope and 1 with mental illness.Of the 43（32.8%）cardiogenic syncope patients,19 were diagnosed with sick sinus syndrome and ≥ Ⅱgrade atrioventricular block,5with paroxysmal ventricular tachycardia,4with atrial fibrillation,1with fast-slow syndrome,2with acute coronary syndrome,5with CHD,4with heart failure and 3with bundle branch block.Of the 131 elderly patients,16（12.2%）were diagnosed with nervous system diseases-induced syncope,10（7.6%）with other factors-induced syncope and 5（3.8%）with uncertain factors-induced syncope.Logistic regression analysis showed that family history,treatment dependence,DM and lipidemia were the high risk factors for neurogenic and cardiogenic syncope.Conclusion Nerve-mediated syncope is the main cause of syncope in elderly patients followed by cardiogenic syncope.