住院晕厥患者病因及诊治状况分析  

Causes,Diagnosis and Treatment of Hospitalized Syncope Patients

作　　者：王立娜[1] 仁晖 陈江天[1] 李忠佑[1] 罗碧芬 李素芳[1] 宋俊贤[1] 陈红[1] 

机构地区：[1]北京大学人民医院心血管内科急性心肌梗死早期预警和干预北京市重点实验室,北京市100044

出　　处：《中国全科医学》2017年第26期3296-3299,共4页Chinese General Practice

摘　　要：背景目前,晕厥的病因诊断仍有一定困难,并存在诊治不规范现象。目的探讨晕厥的病因分布和诊治的不足之处,提高临床医生对晕厥的正确认识。方法选取2006年12月—2016年6月在北京大学人民医院入院和/或出院诊断为"晕厥"和/或"意识丧失"的住院患者为研究对象。收集患者一般资料,以及发作诱因、意识丧失发作前中后症状、"意识丧失"和"晕厥"出现的频次、与"意识丧失"和/或"晕厥"相关的出入院诊断等。结果共纳入509例"晕厥"和/或"意识丧失"患者进行分析,其中病因明确239例,包括晕厥182例(76.2%),非晕厥57例(23.8%)。病因明确的晕厥患者病因依次为神经介导性晕厥(100例,54.9%)、心源性晕厥(59例,32.4%)、直立性低血压性晕厥(17例,9.3%)、其他复合病因晕厥(6例,3.4%)。入院诊断为"晕厥",但病因中包含非晕厥疾病(如癫痫、短暂性脑缺血发作)的患者共116例。出院诊断为"晕厥",但病因中包含非晕厥疾病的患者共21例。84例患者的病程记录中,76例(90.5%)存在"意识丧失"和"晕厥"概念混淆的情况。509例患者共1 084人次发作意识丧失,未记录发作诱因有147人次(13.6%),而未记录前驱症状、发作中或发作后症状分别有354人次(32.7%)、299人次(27.6%)和353人次(32.6%);诊断明确的182例晕厥患者共395人次发作晕厥,未记录发作诱因有47人次(11.9%),未记录前驱症状、发作中或发作后症状分别有131人次(33.2%)、127人次(32.2%)和136人次(34.4%)。临床医生对神经介导性晕厥患者的治疗以教育(43例,43.0%)和功能锻炼(13例,13.0%)为主,心源性晕厥患者多给予植入起搏器(24例,40.7%)或植入型心律转复除颤器(14例,23.7%),直立性低血压性晕厥患者给予调整药物和教育治疗分别为9、3例。上述3种病因所致的晕厥患者中,未给予任何治疗者共39例(22.2%)。结论住院晕厥患者病因主要为神经介导性晕厥,其次为心源性晕厥、直Background So far identifying the causes of syncope is still a challenge,and there are nonstandard diagnosis and treatment for syncope. Objective To explore the causes of syncope and the inadequacies of diagnosis and treatment for it,in order to improve clinical understanding of the disease. Methods We enrolled consecutive patients with the diagnosis of syncope and/or loss of consciousness（ LOC） when admitted to or discharged from Peking University People＇s Hospital between December 2006 and June 2016. The general data,as well as causes of the attack,symptoms presented during the peri-ictal period of LOC,frequency of LOC and syncope,and the associated diagnosis as LOC and/or syncope were collected.Results A total of 509 cases of syncope and/or LOC were analyzed,239 of them had identified causes,including 182 cases（ 76. 2%） of syncope and 57 cases（ 23. 8%） of non-syncope. Neutrally mediated syncope（ NMS） was the most common syncope [54. 9%（ 100/182） ], followed by cardiac syncope [32. 4%（ 59/182） ], then orthostatic hypotension syncope[9. 3%（ 17/182） ],and syncope caused by the above complex causes [3. 4%（ 6/182） ]. There were 137 cases of non-syncope diseases,such as epilepsy and transient ischemic attack,including 116 cases and 21 cases diagnosed as syncope after admitted,and at the time of discharge,respectively. The concepts of syncope and LOC were confused in the medical record of 76（ 90. 5%） among 84 cases. The 509 cases experienced 1 084 LOC events. The missed information related to the events found in the medical record of these cases were the causes of LOC [13. 6%（ 147/1 084） ], the prodromal symptoms of LOC [32. 7%（ 354/1 084） ],symptoms occurred during the attack of LOC [27. 6%（ 299/1 084） ],symptoms occurred after the attack of LOC [32. 6%（ 353/1 084） ], respectively. The 182 cases with identified causes of syncope experienced 395 syncope events. The missed information related to the events found in the medical record of these cases were the causes

关 键 词：晕厥 病因 意识丧失 诊断 治疗 

分 类 号：R544.2[医药卫生—心血管疾病]