不明原因晕厥患者直立倾斜试验反应特点  

Reactive characteristics of head-up tilt table test in the patients with unexplained syncope

作　　者：郑慧芬[1] 王成[1] 何芝香[2] 李茗香[1] 林萍[1] 薛小红[1] 刘晓燕[1] 许毅[1] 

机构地区：[1]中南大学湘雅二医院儿科心血管病研究室中南大学儿科学研究所,长沙410011 [2]湖南省儿童医院呼吸免疫科,长沙410007

出　　处：《中国急救医学》2007年第7期580-583,共4页Chinese Journal of Critical Care Medicine

基　　金："十五"国家科技攻关计划项目(No.2004BA720A10);湖南省科技厅资助项目(No.06SK3036)

摘　　要：目的探讨不明原因晕厥(UPS)患者直立倾斜试验(HUTT)的反应特点。方法2005-01～2006-09在我院就诊或住院的UPS或接近晕厥患者170例,男性64例,女性106例,年龄3～70岁,平均(23.18±15.40)岁,其中儿童(<18岁)88例。比较HUTT阳性与阴性患者的特点,调查阳性患者反应类型与性别、年龄的关系及不同类型阳性反应患者HUTT期间血流动力学的变化。结果①对HUTT结果有显著影响的因素为年龄和HUTT期间的心电图变化。②血管抑制型和混合型在男女性别间比较差异无统计学意义(P>0.05),但在成人(≥18岁)和儿童(<18岁)组间比较差异有统计学意义(P<0.05),血管抑制型和心脏抑制型多见于儿童。③HUTT阳性者心律失常事件发生率较阴性者高,常见窦性心律不齐、窦性心动过缓、窦性心动过速、交界性心律和逸搏。④基础倾斜试验(BHUT)晕厥发作平均时间为(21.61±10.64)min,舌下含服硝酸甘油倾斜试验(SNHUT)晕厥发作平均时间为舌下含服硝酸甘油后(5.58±2.68)min。结论①儿童较成人易于发生阳性反应,以血管抑制型和心脏抑制型居多。②HUTT期间出现心电图变化者阳性反应发生的可能性增加,尤其是窦性心律不齐和窦性心动过缓出现时要警惕阳性反应的发生。Objective To explore the reactive characteristics of head - up tilt table test （ HUTT） in the patients with unexplained syncope （ UPS ）. Methods In 170 patients [ 64 males, 106 females, aged 3 -70 years, mean （23.18 ± 15.40） years] with UPS in our hospital between January 2005 and September 2006, there were 88 children （ 〈 18 years}. To compare the characteristics between positive reactors and negative reactors of HUTT and investigate the correlations of different positive reactors types with sex and age and the hemodynamic variations of patients with different positive reactors type in HUTT. Results （1）Age and change of electrocardiogram had a significant effect on the result of HUTT. （2）Vasodepressor response and mixed response had no significant differences between males and females （ P 〉 0. 05 ）. On the contrary, significant differences existed between adults and children （ P 〈 0.05 ）. Cardio - inhibitory response and vasodepressor response were more in children than adults. （3）The incidence rate of arrhythmia was higher in the positive patients than negative ones. Sinus arrhythmia, sinus bradycardia, sinus tachycardia, junctional rhythm and escape beat were common. （4）Mean time of syncope attack were （ 21.61 ± 10. 64） min in baseline head - up tilt table test （ BHUT）, （ 5.58 ±2.68 ） min after sublingual nitroglycerin in sublingual nitroglycerin tilt test （SNHUT）. Conclusion Positive responses are more in children than adults, especially cardio - inhibitory response and vasodepressor response. Patients with change of electrocardiogram are liable to be positive in HUTT. When sinus arrhythmia and sinus bradycardia appear, we should be on guard against positive response.

关 键 词：不明原因晕厥 直立倾斜试验 

分 类 号：R540.4[医药卫生—心血管疾病]