血管迷走性晕厥在直立倾斜试验时房室间期变化的研究

Study of atrioventricular interphase changes in patients with vasovagal syncope during head-up tilt table

目的血管迷走性晕厥在直立倾斜试验中房室间期变化。方法收集2018年1月至2020年12月江门市中心医院门诊及住院共78例直立倾斜试验阳性的晕厥、晕厥先兆患者(男性34例,女性44例,平均年龄37.87±19.10岁),并分析了直立倾斜试验期间患者在平卧位、直立倾斜位、晕厥前和恢复平卧位后的房室间期数据。结果其中2型血管迷走性晕厥患者在晕厥前房室间期为(150.50±10.60)ms,较直立倾斜位的(132.50±7.33)ms延长(P<0.05);1型血管迷走性晕厥患者在晕厥前房室间期为(118.29±7.78)ms,较直立倾斜位的(133.14±5.38)ms缩短(P<0.05);3型血管迷走性晕厥患者在晕厥前房室间期为(122.10±6.25)ms,较直立倾斜位的(139.93±4.32)ms缩短(P<0.05)。年龄分析结果显示,儿童组别中各类型的晕厥前房室间期较直立倾斜位均缩短,但在3型血管迷走性晕厥中两者之间差异没有统计学意义,成年组中1型血管迷走性晕厥及3型血管迷走性晕厥患者晕厥前房室间期较直立倾斜位均缩短,而2型血管迷走性晕厥则延长。不同性别的比较分析显示,男性及女性在各型晕厥时各体位的房室间期变化情况与总体分析的结果类似。结论血管迷走性晕厥1型在晕厥或晕厥先兆时伴随房室间期延长、窦性搏动减慢或高度以上的房室阻滞,甚至心脏停搏,而1型及3型血管迷走性晕厥出现房室间期缩短,提示不同类型的血管迷走性晕厥对房室间期影响机制不一样,可作为今后晕厥发生的预警。儿童组自主神经系统功能尚未成熟,结果与成人不同,但需要加大样本量再进行分析。

Objective To study the changes of atrioventricular interval in different types of vasovagal syncope in head up tilt table test.Methods A total of 78 patients with syncope and syncope aura with positive head up tilt test(34 males and 44 females,with an average age of 37.87±19.10 years)from January 2018 to December 2020 in the outpatient and inpatient departments of Jiangmen Central Hospital were collected,and the atrioventricular interval data of patients in horizontal position,vertical tilt position,before syncope and after returning to horizontal position during the head up tilt test were analyzed.Results The atrioventricular interval of patients with cardiac inhibitory vasovagal syncope was(150.50±10.60)ms,which was longer than(132.50±7.33)ms in upright tilt position(P<0.05);The PR interval before syncope in patients with mixed vasovagal syncope was(118.29±7.78)ms,which was shorter than(133.14±5.38)ms in oblique position(P<0.05);The PR interval before syncope in patients with vasoinhibitory vasovagal syncope was(122.10±6.25)ms,which was shorter than that in tilt position(139.93±4.32)ms(P<0.05).The results of age analysis showed that the PR interval of all types of syncope in the child group was shorter than that in the upright tilt position,but there was no significant difference between the two in the vascular inhibitory vasovagal syncope.The PR interval of vasovagal syncope type 2 and vasovagal syncope type 3 syncope in the adult group was shorter than that in the upright tilt position,while that in the cardiac inhibitory type was longer.The comparative analysis of different genders showed that the changes of PR interval of men and women in various postures during various types of syncope were similar to the results of the overall analysis.Conclusions During syncope or syncope aura,cardiac inhibitory vasovagal syncope is accompanied by prolonged atrioventricular interval,slow sinus beat or atrioventricular block above height,and even cardiac arrest,while vascular inhibitory and mixed vasovagal syncope have shortened PR interval,suggesting different production mechanisms of different types of vasovagal syncope,which can be used as an early warning of syncope in the future.The mechanism of autonomic nervous system function in children group is different from that in adults,but it needs to increase the sample size for analysis.