血管迷走反应的临床研究进展

Clinical research progress of vasovagal reaction

血管迷走反应(VVR)是一个常见的医学问题,可由心理、生理(如突然体位变化、长久站立、闷热环境、失血等)及侵入性医疗操作(如注射、抽血、牙齿保健、颈动脉支架血管成形术等)等应激引起,VVR的心理学和生理学机制仍不完全清楚。心电图是鉴别诊断神经源性晕厥或心源性晕厥的基石,直立倾斜试验有助于判断神经源性晕厥的类型;机体对情绪的生理反应模式及VVR的心理学理论仍需进一步完善;献血应激为研究轻度失血应激、VVR的病理生理学机制提供了较为客观的真实模型;颈动脉支架血管成形术为研究刺激血管内压力感受器引起的VVR提供一项独特的方法 。

Vasovagal reaction （VVR） can be elicited by psychological stress, physical stressors （abrupt postural change, prolonged standing, warm environment, hemorrhage） and invasive medical procedures（ injection, blood drawing, dental treatment, carotid artery stenting）. The psychological and physiological mechanisms of VVR remain unclear. Electrocardiogram is the cornerstone for differential diagnosis of neurogenic syncope and cardiac syncope. Head-up tilt test helps to differentiate the predominant type of neurogenic syncope. The physiological reaction model of emotion and the psychological theory of VVR still need further investigation. Blood donation stress provides a real model for studying mild blood loss stress and pathophysiological mechanisms of VVR. Carotid artery stenting offers a unique method for elucidating the pathophysiological process of VVR induced by intravascular stimulation of baroreceptors.