中国成人晕厥患者临床特征分析:一项多中心 研究

Clinical characteristics of adult Chinese patients with syncope:a multicenter clinical study

目的分析中国成人晕厥患者的临床特征。方法该研究为横断面调查。连续纳入2018年6月25日至2021年3月1日中国19个省市自治区、香港特别行政区37家三甲医院急诊、老年科、心内科门诊或晕厥单元就诊且初步诊断为晕厥的患者,收集相关临床资料,并对其临床特征进行分析。结果研究共纳入患者4950例,年龄(56.3±16.8)岁,男性2604例(52.6%)。最常见的晕厥类型为神经介导性晕厥[2345(47.4%)],其次为心原性晕厥[1085(21.9%)],而直立性低血压性晕厥则相对少见[311(6.3%)],此外不明原因晕厥患者有1155例(23.3%)。与≥65岁的患者比较,<65岁的患者中有诱因者更为多见[2066(72.4%)比786(27.6%),χ^(2)=136.5,P<0.001]。与其他类型晕厥患者比较,神经介导性晕厥患者中有晕厥先兆者占比较高[1972(79.0%)比1908(73.9%),χ^(2)=17.523,P<0.001]。女性患者中有先兆者占比高于男性[1837(80.0%)比1863(73.0%),χ^(2)=33.432,P<0.001]。<65岁的患者中有先兆者占比高于≥65岁者[2482(77.8%)比1218(73.4%),χ^(2)=11.756,P=0.001]。与<65岁的患者比较,≥65岁者伴紫绀的比例较高[271(18.2%)比369(12.7%),χ^(2)=23.235,P<0.001],伴大小便失禁的比例亦较高[252(15.2%)比345(10.8%),χ^(2)=19.313,P<0.001]。与其他类型晕厥的患者比较,心原性晕厥患者有家族史者更为多见[264(24.3%)比754(19.5%),χ^(2)=11.899,P=0.001]。晕厥患者合并的心血管疾病依次为高血压[1480(30.5%)]、冠心病[1057(21.4%)]、心房扑动/颤动[359(7.2%)]和二度房室传导阻滞[236(4.8%)]。心原性晕厥患者合并冠心病的比例远高于其他类型的晕厥患者[417(38.4%)比640(16.6%),χ^(2)=241.376,P<0.001]。此外,合并症还包括脑血管病[551(11.1%)]和糖尿病[632(12.8%)]。结论中国成人晕厥以神经介导性晕厥最为常见,有诱因、先兆的患者较为年轻,女性有晕厥先兆者占比较高,心原性晕厥患者中有家族史、合并冠心病的比例较高。

Objective To analyze the clinical characteristics of adult Chinese patients with syncope.Methods This is a cross-sectional survey study.Patients with preliminary diagnosis of syncope in the Emergency Department,Geriatrics and Cardiology Outpatient Department,or Syncope Unit of 37 hospitals in 19 provinces,autonomous regions and the Hong Kong Special Administrative Region from June 2018 to March 2021 were included in this study.The clinical features of these patients with syncope were analyzed.Results A total of 4950 consecutive patients with syncope were included in this study.The age was(56.3±16.8)years,and 2604 cases(52.6%)were male.The most common type of syncope was neurally mediated syncope(2345(47.4%)),followed by cardiac syncope(1085(21.9%)),orthostatic hypotensive syncope(311(6.3%)),and unexplained syncope accounted for nearly one third(1155(23.3%)).Predisposing syncope was more common in patients under 65 years of age(2066(72.4%)vs.786(27.6%),χ^(2)=136.5,P<0.001).Presyncope was more common in patients with neurally mediated syncope(1972(79.0%)vs.1908(73.9%),χ^(2)=17.756,P<0.001).Premonitory symptoms were more common in women(1837(80.0%)vs.1863(73.0%),χ^(2)=33.432,P<0.001).Presyncope syndrome was more common in patients under 65 years of age(2482(77.8%)vs.1218(73.4%),χ^(2)=17.523,P=0.001).Cyanosis was more common in≥65 years old patients(271(18.2%)vs.369(12.7%),χ^(2)=23.235,P<0.001).Urinary incontinence was more common in old patients aged≥65 years(252(15.2%)vs.345(10.8%),χ^(2)=19.313,P<0.001).Family history was more common in patients with cardiogenic syncope compared with other types of syncope(264(24.3%)vs.754(19.5%),χ^(2)=11.899,P=0.001).Hypertention(1480(30.5%)),coronary heart disease(1057(21.4%)),atrial flutter and atrial fibrillation(359(7.2%)),second degree atrioventricular block(236(4.8%))were common complications of syncope.The proportion of patients with coronary heart disease was significantly higher in cardiac syncope than that of other types of syncope(417(38.4%)vs.640(16.6%),χ^(2)=241.376,P<0.001).Other common complications included cerebrovascular diseases(551(11.1%))and diabetes mellitus(632(12.8%)).Conclusions Neurally mediated syncope is the most common syncope in adult Chinese population.Patients with predisposing conditions and premonitory conditions are younger.Presyncope is more common in women.The proportion of family history and coronary heart disease is higher in patients with cardiogenic syncope.