血管迷走性晕厥患者直立倾斜试验初期血流动力学特征

Hemodynamic Characteristics in the Initial Phase of Head-up Tilt Test in Patients with Vasovagal Syncope

目的分析血管迷走性晕厥(vasovagal syncope,VVS)患者在直立倾斜试验(head-up tilt test,HUTT)初始阶段的血流动力学变化。方法连续入选2016年6月-2019年12月在首都医科大学附属北京天坛医院神经心脏病学中心就诊并进行HUTT的VVS患者进行回顾性研究。分析HUTT结果阴性及不同阳性类型患者在HUTT平卧期和倾斜初期的收缩压、舒张压、平均动脉压、心率、每搏量、心输出量、系统血管阻力的差异。结果研究共入组VVS患者303例,其中HUTT阴性组102例(33.7%),HUTT阳性患者中混合型组67例(22.1%)、血管减压型组132例(43.6%)、心脏抑制型组2例(0.6%)(例数过少未纳入统计分析)。混合型组在平卧期收缩压、平均动脉压、每搏量、心输出量均显著低于HUTT阴性组(均P<0.05),在倾斜初期收缩压、平均动脉压、每搏量、心输出量均低于HUTT阴性组;血管减压型组在平卧期舒张压、平均动脉压低于HUTT阴性组,在倾斜初期收缩压、舒张压和平均动脉压低于HUTT阴性组。混合型组平卧期和倾斜初期心输出量均低于血管减压型组,系统血管阻力均显著高于血管减压型组(均P<0.05)。结论不同HUTT结果的VVS患者在倾斜试验初始阶段已存在了明显的血流动力学差异。

Objective To analyze the hemodynamic changes in patients with vasovagal syncope(VVS)in the initial phase of head-up tilt test(HUTT).Methods VVS patients admitted to Neurocardiology Clinical and Research Center of Beijing Tiantan Hospital who underwent HUTT were enrolled in a retrospective study.Hemodynamic changes in the initial phase of HUTT were analyzed among patients with HUTT negative result and different positive results,including systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR),stroke volume(SV),cardiac output(CO),systemic vascular resistance(SVR)during supine position and early tilt.Results 303 VVS patients were included,including 102 cases in negative group,67 in mixed group,132 in vasodepressor group and 2 in cardioinhibitory group(the number of cases is too small to be included in the statistical analysis).SBP,MAP,SV and CO were all lower in mixed group than that in negative group in supine position(all P<0.05);SBP,MAP,SV,CO were all lower in mixed group than that in negative group in early tilt(all P<0.05).DBP and MAP were lower in vasodepressor group than that in negative group in supine position(all P<0.05);SBP,DBP,MAP were all lower in vasodepressor group than that in negative group in early tilt(all P<0.05).CO was lower in mixed group than that in vasodepressor group both in supine position and early tilt(both P<0.05),SVR was higher in mixed group than that in vasodepressor group both in supine position and early tilt(both P<0.05).Conclusions VVS patients with different HUTT results showed obvious hemodynamic difference in the initial phase of this test.