血管迷走性晕厥患者倾斜试验静滴艾司洛尔对口服β-阻滞剂疗效的预测研究

Predict efficiency of oral P-adrenergic blocker therapy in patients with vasovagai syncope by intravenous esmolol in head-uptilt table testing

目的:探讨血管迷走性晕厥(vasovagal syncope,VVS)患者基础倾斜试验(baseline head-up tilt testing,HUT)及舌下含化硝苯地平倾斜试验(sublingual nifedipine head-up tilt testing,SNHUT)时静滴艾司洛尔对预测口服β-受体阻滞剂疗效的价值。方法:对58例VVS患者进行HUT,HUT阴性者再进行SUHUT。对于34例阳性患者,立即静脉滴注文司洛尔,并再次行HUT。然后,均口服长效β-受体阻滞剂美托洛尔,1周后重复HUT。结果:58例首次HUT者中阳性34例(阳性率58.6％)。34例阳性者在静滴艾司洛尔后,29例(85.3％)HUT转为阴性,而5例(14.7％)HUT仍为阳性,口服美托洛尔,1周后重复HUT。结果文司洛尔29例阴性组患者中24例(82.8％)再次阴性,继续口服美托洛尔9.7±3.4个月仍无晕厥发作,说明美托洛尔有效;5例(17.2％)转为HUT阳性(美托洛尔无效)。艾司洛尔阳性的5例患者服美托洛尔后4例(80％)仍为HUT阳性(无效),另外1例转为HUT阴性(有效)。如不计艾司洛尔试验结果,则34例HUT阳性者口服美托洛尔后的最后效果是25例阴性(有效),有效率73.5％,显著低于艾司洛尔阴性者的82.8％(P<0.05)。结论:VVS患者HUT静脉滴注艾司洛尔对口服美托洛尔疗效有预测价值。

To determine the value of intravenous esmolol to predict efficacy of oral beta-adrenergic blocker therapy in patients with vasovagal syncope (VVS). Methods: A total of 58 patients were underwent HUT and 34 patients who had a positive HUT were then given a continuous esmolol infusion in second HUT. Irrespective of their response to esmolol infusion, all 34 patients had a follow-up HUT after with oral metoprolol 1 week. Results: (1) Thirty-four patients (58. 6%) had a positive HUT in patients with HUT and SNHUT; (2) Twenty-nine patients had a negative HUT and 5 patients had a positive HUT during esmolol infusions (3) Twenty-four patients (82. 8%) of 29 patients with esmolol negative HUT were still negative HUT (efficacy for metoproloDand another 5 patients (17. 2%) with a positive HUT after with oral metoprolol 1 week; (4) Irrespective of their response to esmolol infusion the 34 patients had 25 patients with negative HUT (73.5%) and 9 patients had positive HUT (26.5%) after with oral metoprolol; (5) The efficiency (82. 8%) of esmolol negative group (29 cases) was more than 34 patient with positive HUT (73. 5%) (P<0. 05). Conclusion: It is concluded that esmolol can predict the outcome of oral metoprolol in VVS patients, may be helpful for screening patient with metoprolol treatment.