直立倾斜试验对咳嗽性晕厥患者的诊断价值研究

Diagnostic value of head-up tilt test in patients with cough syncope

目的探讨直立倾斜试验(HUT)对咳嗽性晕厥(CS)的诊断价值。方法选取2011年1月至2016年5月该院门诊或住院CS患者47例作为观察组,同期有晕厥史的拟诊为血管迷走性晕厥(SVVS)的患者79例为对照组。两组均行HUT,观察HUT中咳嗽反应,咳嗽引发收缩压、舒张压及心率变化,HUT阳性结果及血流动力学类型。结果观察组患者咳嗽诱发晕厥4例(8.51%),晕厥先兆26例(55.32%),无症状17例(36.17%),对照组79例(100.00%)均无症状,差异有统计学意义(P<0.05)。观察组咳嗽反应总阳性率为63.83%,特异性为100.00%。各组患者收缩压比较差异均有统计学意义(P<0.05)。观察组无症状者舒张压与观察组晕厥者、观察组晕厥先兆者比较差异有统计学意义(P<0.05),与对照组无症状者比较差异无统计学意义(P>0.05)。各组心率比较差异无统计学意义(P>0.05)。观察组患者HUT阳性率低于对照组(P<0.05),两组间血流动力学类型差异均无统计学意义(P>0.05)。结论 HUT中剧烈咳嗽可引起CS患者血压下降,诱发晕厥或晕厥先兆,能提高CS患者诊断的敏感性,对怀疑诊断为CS的患者,尤其是病史不清的CS患者的诊断是十分有益的。

Objective To investigate the diagnostic value of head-up tilt test （HUT） in cough syncope （CS）. Methods Forty-seven outpatients or inpatients with CS and 79 patients with suspected vasovagal syncope（SVVS） due to syncope history m our hospital from January 2011 to May 2015 served as the observation group and control group respectively. HUT was performed in the two groups. The cough response during HUT,changes of systolic pressure and diastolic pressure caused by cough, HUT positive results and hemodynamic type were observed. Results In the observation group, 4 cases（8.51%） were cough caused syncope,26 cases（55.32%） were presyncope and 17 cases （36.17%） had no symptoms.while 79 cases in the control group had no symptoms, the differences were statistically significant （P〈 0. 05）. The total positive rate of cough response in the observation group was 63.83% ,and the specificity was 100.00%. The systolic blood pressure had statistical difference between the two groups（P〈 0.05）. The diastolic pressure had statistical difference between the cases of non-symptoms with the cases of syncope and cases of presyncope in the observation group （P〈0.05）. but had no statistical difference compared with the cases of non-symptoms in the control group（P〉0. 05）, The heart rate（HR） had no statistical difference among various groups（P〉0.05）. The HUT positive rate in the observation group was lower than that in the control group（P〈0.05）. The hemodynamic type had no statistical difference between the two groups（P〉0.05）. Conclusion Severe coughing during HUT may cause the blood pressure decrease.induces syncope or presyncope,can increase the diagnostic sensitivity of CS patients, which is very useful in the suspected diagnosis of CS patients,especially for CS patients with a unclear history.