单中心晕厥住院患者的病因分析

Clinical Characteristics,Etiological Distribution of Inpatients Presenting With Syncope:A Single-center Experience

目的:分析单中心晕厥住院患者基础疾病、临床特征和病因分布情况。方法:入选2014-09至2017-04中国医学科学院阜外医院心律失常诊治中心收治的晕厥患者,依据晕厥诊断与治疗指南或专家共识进行危险分层,并分析临床特征及病因分布。结果:在5 191例住院患者中,入选了末次晕厥发生在入院前180天内的300例患者,男性177例(59.0%),平均年龄(57.7±15.4)岁,29例(9.7%)为复发性晕厥,242例(80.7%)为高危患者;144例(48.0%)患者存在先天性心脏病、心肌病、冠状动脉粥样硬化性心脏病、瓣膜病等基础心脏疾病。266例(88.7%)能够明确病因诊断,其中214例(71.3%)为心原性晕厥、44例(14.7%)为神经介导反射性晕厥、8例(2.7%)为低血容量及体位性低血压性晕厥。缓慢型心律失常最多见,为112例(37.3%)。结论:在本中心晕厥住院患者中,绝大多数可明确病因,高危晕厥患者和缓慢型心律失常比例高,针对病因及时治疗有助于改善患者预后。

Objectives： To analyze the clinical characteristics, etiological distribution of inpatients with syncope in our center.Methods： Patients with syncope were consecutively enrolled from September 2014 to April 2017 in Center of Arrhythmia of Fuwai Hospital. Demographics, medical history, physical examination results and laboratory tests were collected according to screen algorism to investigate the possible etiologies of syncope. Risk stratification was performed based on guidelines for the diagnosis and management of syncope（version 2009,ESC）and Chinese expert consensus on the diagnosis and treatment of syncope（version 2014）.Results： After collecting medical history, physical examination and performing laboratory tests, three hundred patients who experienced the latest syncope within 180 days before admission was identified from 5 191 patients, the average age was（57.7 ± 15.4） years, 177（59.0%） were male, 235（78.3%） experienced syncope within 30 days before admission, 9.7% patients had recurrent episodes, 80.7% were defined as high risk syncope patients, 144（48.0%）patients suffered structural heart disease. Cardiac syncope was the most common etiology（214 cases,71.3%）, followed by reflex syncope（44 cases,14.7%） and orthostatic hypotension（8 cases,2.7%）, while etiology was not identified in the rest 34 patients（11.3%）. Among all the etiologies of syncope, brandy arrhythmia was the most common reason for syncope（37.3% [112 cases]）. During onset of syncope prior to hospitalization, five patients were diagnosed with severe intracranial hematoma or cerebral hemorrhage, six cardiopulmonary resuscitations were performed, and eleven patients received external direct current cardioversion.Conclusions： Etiology could be defined in most of the syncope patients admitted to our center, the prevalence of high-risk syncope and syncope due to brady arrhythmias is high in this patient cohort, treatments of the syncope patients could be improved by etiological and timely prognosis.