舌下含服硝酸甘油直立倾斜试验对血管迷走性晕厥的诊断价值  

The Diagnostic Value of Head-Up Tilt Testing Potentiated With Sublingual Nitroglycerin in Patients With Vasovagal Syncope.

作　　者：林文华[1] 任自文[1] 童琳[1] 孙学敏 冯晋珠 高萌[1] 丁燕生[1] 周菁[1] 杨俊娟[1] 韩兰唐[2] 梁玉芝[3] 

机构地区：[1]北京大学第一医院心内科,北京100034 [2]张家口医学院第一附属医院 [3]河南省商丘市第一人民医院

出　　处：《中国心脏起搏与心电生理杂志》2000年第4期230-233,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：为寻找使用方便、省时、耐受性良好的倾斜方案 ,将不明原因晕厥者 91例、无晕厥史者 5 2例 (对照 )分别随机分为异丙肾上腺素组 (A组 ,患者 45例、对照 2 6例 )和硝酸甘油组 (B组 ,患者 46例、对照 2 6例 )。每组首先行 70°30min的基础倾斜试验 (BHUT) ,若为阴性则加用药物激发。A组在BHUT结束后将倾斜床放回水平位 ,静脉注射异丙肾上腺素 (剂量 3μg/min) 5min ,再次倾斜 70° 10min。B组在BHUT结束后同一倾斜角度给予硝酸甘油 0 .2mg舌下含服 ,持续倾斜 2 0min。结果 :A组BHUT阳性率为 11.1% (5 / 45 ) ,加用药物后阳性率为 42 .2 % (19/ 45 ) ;总敏感性5 3 .3 %、特异性 88.5 % ;3例 (6 .7% )出现胸闷、胸痛不能耐受试验。B组BHUT阳性率为 10 .9% (5 / 46 ) ,加用药物后阳性率为 45 .7% (2 1/ 46 ) ;总敏感性 5 6 .5 %、特异性 92 .3%。结论 :含服硝酸甘油激发试验具有良好的敏感性和特异性 ,且使用方便、省时、耐受性好 ,可做为诊断血管迷走性晕厥的常规方法。The aim of our study was to evaluate the diagnostic value of head up tilt testing potentiated with sublingual nitroglycerin (NHUT) in patients with unexplained syncope,and compare its result with isoproterenol potentiating head up tilt testing (IHUT).91 patients (40 male and 51 female,mean age 38.5±14.4 years,from 13 to 70) with syncope of unknown origin and 52 subjects in a control group (28 male and 24 female,mean age 26.0±5.2 years,from 20 to 37) were randomized into two groups.Eeach group were tilted upright to 70 degrees for 30 minutes as baseline head up tilt testing (BHUT).If syncope did not occur,different drugs were given:Group A (45 patients and 26 subjects in control group):returned to supine position at the end of BHUT,intravenous isoproterenol was given at a rate of 3 μg/min and continued for 5 minutes,then tilted at 70 degress for 10 minutes.Group B (46 patients and 26 subjects in control group):at the end of BHUT,sublingual nitroglycerin (0.2 mg) was administered,and observation was continued at the same angle for 20 minutes.Results:Group A:Five of forty five patients (11.1%) had positive response to BHUT,another nineteen (42.2%) to IHUT.The mean time to syncope was 4.0±2.9 minutes (from 0.5 to 9 minutes),total positive rate and specificity were 53.3% and 88.5%,three cases (6.7%) couldn't tolerate the test because of chest stress.Group B:Five of forty six patients (10.9%) had positive response to BHUT,another twenty one patients (45.7%) had a positive response after NHUT.The mean time to syncope was 5.9±2.9 minutes (from 2 to 16 minutes),total positive rate was 56.5%,specificity was 92.3%,four cases had mild headache.Conclusion:Head up tilt testing potentiated with sublingual nitroglycerin (0.2 mg) as pharmacological provocation test had a upstanding sensitivity and specificty,it had a lot of merits,such as convenience,time saving,well tolerated and so on.

关 键 词：血管迷走性晕厥 倾斜试验 硝酸甘油 诊断 

分 类 号：R544.204[医药卫生—心血管疾病]