舌下含化硝苯地平倾斜试验对血管迷走性晕厥的诊断价值

Value of head-up tilt testing with sublingual nifedipine for the diagnosis of vasovagal syncope

目的 探讨舌下含化硝苯地平倾斜试验 (sublingualnifedipinehead uptilttesting ,SNHUT)对血管迷走性晕厥 (vasovagalsyncope ,VVS)的诊断价值。方法 4 8例VVS患者 (VVS组 )及 4 4例无晕厥病史的健康体检者 (对照组 )先进行基础倾斜试验 (baselinghead uptilttesting ,BHUT) ,阴性者再进行舌下含化硝苯地平倾斜试验。 结果 VVS组 4 8例中 ,BHUT阳性 12例 ,阳性率 2 5 % ,而对照组为 0 ,阳性者由平卧位至HUT阳性时心率由 (72 .3± 8.9)次 /min降至 (5 5 .9± 11.4 )次 /min(P <0 .0 1) ,平均动脉压由 (80 .3± 11.5 )mmHg降至 (5 0 .7± 10 .6 )mmHg(P <0 .0 1)。VVS组剩余 36例SNHUT阳性 16例 ,阳性率 4 4 .4 % ,而对照组仅 2例阳性 ,阳性率 4 .6 %。VVS组阳性者由平卧位至HUT阳性时心率明显下降 [(6 5 .8± 7.7)次 /min降至 (5 3.7± 10 .8)次 /min(P <0 .0 1) ,平均动脉压由 (78.3± 10 .9)mmHg降至 (48.6± 11.1)mmHg(P <0 .0 1) ]。SNHUT阳性组从倾斜开始至出现阳性反应的时间比BHUT阳性组明显缩短 ,分别为 (10 .3± 9.8)min与 (19.3± 11.7)min(P <0 .0 5 )。VVS组仅 2例而对照组仅 1例出现头痛、面红等副作用 ,但均能坚持试验。结论 SNHUT方法诊断VVS ,敏感性好 ,特异性高 。

Objective To determine the value of head up tilt testing with sublingual nifedipine for the diagnosis of vasovagal syncope. Methods Forty eight patients with vasovagal syncope and forty four healthy subjects in control group were studied. The patients and the control subjects underwent baseline head up tilt testing (BHUT). If positive response did not occur, sublingual nifedipine head up tilt testing (SNHUT) was conducted. Results During BHUT 12 patients(25%) and no controls had a positive response. The heart rate and mean arterial pressure of 12 patients decreased respectively[from( 72.3 ± 8.9 ) beats/min to( 55.9 ± 11.4 ) beats/min(P< 0.01 ),from ( 80.3 ± 11.5 ) mm Hg to ( 50.7 ± 10.6 ) mm Hg(P< 0.01 )]. During SNHUT the positive response occurred in 16 patients( 44.4 %) with vasovagal syncope and 2 controls( 4.6 %). The heart rate and mean arterial pressure of 16 patients with vasovagal syncope decreased respectively[from( 65.8 ± 7.7 ) beats/min to( 53.7 ± 10.8 ) beats/min(P< 0.01 ),from( 78.3 ± 10.9 ) mm Hg to ( 48.6 ± 11.1 ) mm Hg(P< 0.01 )]. The mean time from tilt to positive response was ( 19.3 ± 11.7 ) min in during BHUT 12 patients with positive response, ( 10.3 ± 9.8 ) min in during SNHUT 16 patients with positive response(P< 0.05 ). Two patients and one control subject in this study had side effects of headache,flush and others,but all could bear the test. Conclusion These date indicated that SNHUT for diagnosis of vasovagal syncope may be a pragmatic clinical technique with sensitivity and specificity and little side effects.