舌下含服消心痛直立倾斜试验对血管迷走性晕厥的诊断价值

Diagnostic value of head-up tilt testing with sublingual isosorbide dinitrate in vasovagal syncope

目的 探讨舌下含服消心痛直立倾斜试验 (SISD HUT)对血管迷走性晕厥 (VS)的诊断价值。方法 对 87例晕厥患者 (VS组 )和 40例健康人 (对照组 )行基础直立倾斜试验 (B HUT) ,阴性者再行SISD HUT ,观察倾斜前后血压、心率、十二导联心电图、症状以及服用消心痛以后的变化。结果 B HUT阳性诱发率在VS组为 2 4%、对照组为2 .5 %;VS组和对照组在SISD HUT中的阳性诱发率分别为 5 6 .1%(37/6 6 )和 15 .4%(6 /39) ;B HUT和SISD HUT在VS组中诱发阳性的时间分别是 5～ 2 7min、平均 (19± 13)min和 2～ 8min、平均 (4± 6 )min ,两组相比有显著性差异(P <0 .0 5 ) ;消心痛引起低血压的发生率在VS组和对照组分别为 9.1%和 7.7%;SISD HUT诱发VS的敏感性 6 6 .7%,特异性是 85 %。结论 SISD HUT对VS的诊断有较高的特异性和敏感性 ,且方便易行 ,安全可靠。

Objective To study the value of head-up tilt table test with sublingual isosorbide dinitrate for the diagnosis of vasovagal syncope.Methods Eighty-seven patients with vasovagal syncope and 40 subjects in control group were studied. The patients and the control group underwent baseline head-up tilt table tests(B*.HUT).If positive response did not occur,sublingual isosrbide dinitrate head-up tilt tests(SISD*.HUT) was done on them.Blood pressure,heart rate,12*.lead electrocardiogram and symptom were observed before and after tests and changes after sublingual isosorbide dinitrate were collected. Results Positive rates with B-HUT were 24% and 2.5% in VS and the controls respectively,while they were 56.1%(37/66) and 15.4%(6/39) respectively when with SISD-HUT.The positive-inducing time in VS were (19±13)(5～27)min and(4±6)(2～8)min by B*.HUT and by SISD*.HUT respectively(P<0.05).The rates of hypotension drug-induced were 9.1% in VS and 7.7% in control.The sensitivity and specificity were 66.7%and 85% in VS by SISD*.HUT.Conclusions SISD*.HUT is more sensitive and specific for VS diagnosis and is convenient and safe.