对拟诊血管迷走性晕厥患者进行直立倾斜试验的时程  

Timing of positive head-up tilt test for patients with suspected vasovagal syncope

作　　者：刘俊[1] 刘悦[1] 卢国英[1] 李智[1] 李晓枫[1] 王玉山[1] 方丕华[1] 

机构地区：[1]中国医学科学院,北京协和医学院,心血管病研究所,阜外心血管病医院功能检测中心,100037

出　　处：《中华心血管病杂志》2011年第6期494-496,共3页Chinese Journal of Cardiology

摘　　要：目的 探讨直立倾斜试验的不同阶段诱导出阳性反应的合适时程.方法 回顾性分析因临床拟诊血管迷走性晕厥而进行直立倾斜试验的773例患者检查资料.直立倾斜试验分为30 min的倾斜位（70°）基础试验阶段和20 min的药物（硝酸甘油0.2 mg舌下含化）激发阶段.结果 直立倾斜试验阳性率为55.2%,其中43例（10.1%）患者阳性反应出现在基础试验阶段,384例（89.9%）出现在药物激发阶段.在基础试验阶段,阳性反应中2例（4.7%）发生在倾斜位7.5 min以后;随着时间延长,阳性反应比例逐渐增加,9例（20.9%）在22.5 min达到最高,之后逐渐下降;93%的阳性反应发生在倾斜位10～25 min内.在硝酸甘油激发阶段,阳性反应发生率在服药后迅速上升,35.7%在10 min达到最高,之后迅速下降;96.1%的阳性患者发生阳性反应在服药后的15 min内.结论 直立倾斜试验的倾斜位时间至少25 min,而药物激发阶段时间至少15 min,继续增加时间并不能明显提高阳性率.Objective To investigate the time course of positive head-up tilt test （HUTT） for patients with suspected vasovagal syncope.Methods Consecutive patients referred to the syncope unit of our center for recurrent unexplained syncope were included. The HUTT consisted of a 30 minute passive basic phase and a 20 minute sublingual nitroglycerin provocation phase if syncope did not develop during the passive phase.Results Positive HUTT was observed in 427 out of 773 consecutive patients （55.2%） patients including 43 patients （10.1%） during the passive basic phase and 384 patients （89.9%） during the nitroglycerin provocation phase. During the basic phase, the positive Hutt developed at 7.5 minute （n=2） and peaked at 22.5 th minute （20.9%, n=9） and then decreased gradually. Most positive reactions （93.0%, n=40） occurred between the 10 and 25 minutes during the basic phase. During the nitroglycerin provocation phase, the percentage of positive reactions increased rapidly after sublingual nitroglycerin, peaked at the 10th minute （35.7%, n=137） and decreased thereafter. Most positive reactions （96.1%, n=369） occurred within the first 15 minutes of provocation phase.Conclusion The appropriate duration for HUTT test could be modified to a 25 minutes passive basic phase plus 15 minutes nitroglycerin provocation phase.

关 键 词：晕厥 血管迷走神经性 直立倾斜试验 

分 类 号：R541[医药卫生—心血管疾病]