血管迷走性晕厥的诊断和管理

Vasovagal syncope: diagnosis and management

血管迷走性晕厥(VVS)属于神经介导性晕厥,是最常见、最难以管理的晕厥类型。VVS的诊断主要基于全面的病史采集、体格检查和心电图检查,直立倾斜试验和长时程心电监测有助于提高诊断精确度。健康教育和物理训练是VVS管理的基石,治疗效果不佳时可考虑药物治疗。心脏起搏治疗和心脏神经节丛消融治疗有望成为VVS治疗的新手段,但需严格掌握适应证。本文旨在对血管迷走性晕厥的诊断和管理作简要综述。

Vasovagal syncope(VVS)classified into neutrally mediated syncope is the most common type of syncope and is one of the most difficult types to manage.For its diagnosis,diligent history,physical examination and baseline electrocardiogram are required and additional investigations including head-up tilt testing and long-term cardiac monitoring can be useful to elevate the diagnostic accuracy of VVS.Patient education and physical counter-pressure maneuvers are the cornerstones for VVS management.Medical treatment is usually not required unless conservative measures are unsatisfactory.Cardiac pacing and catheter ablation may emerge as promising approaches for the highly symptomatic patients.This article reviews the diagnosis and management of VVS.