晕厥的危险分层——欧美晕厥诊断与处理指南解读  

The risk stratification of syncope: interpretation of 2018 ESC and 2017 ACC/AHA/HRS guidelines for the diagnosis and management of syncope

作　　者：刘文玲[1] Liu Wen-ling(Department of Cardiology,Peking University People＇s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心内科,北京100044

出　　处：《实用心电学杂志》2018年第3期153-156,161,共5页Journal of Practical Electrocardiology

基　　金：国家自然科学基金资助项目(81270166)

摘　　要：晕厥是一种常见症状。神经介导性晕厥预后良好;直立性低血压导致的晕厥猝死风险较低;心源性晕厥预后差,有些可能是猝死先兆。经初始评估,约1/3的晕厥患者原因不明,因此对晕厥的危险分层十分重要,决定了对患者的临床处理策略。2017年ACC/AHA/HRS晕厥诊断与处理指南将晕厥分为短期风险和长期风险。不同于以往版本,该版指南将男性、年龄、肿瘤、脑血管疾病、糖尿病、CHADS-2评分高和肾功能也纳入危险分层。2018年ESC发布的晕厥诊断和处理指南根据病史、体征、辅助检查,将患者分为高危和低危,并建议对高危患者积极检查,治疗,对低危患者以进行患者教育、改变生活方式及行物理治疗为主。Syncope is a common symptom. Neurocardiogenic syncope has a good prognosis; syncope induced by orthostatic hypotension is at a low risk of sudden death; cardiogenic syncope has a poor prognosis and sometimes is probably a sign of sudden death. The causes of about 1/3 of syncope are unknown after initial evaluation. Therefore,it is very important to make risk stratification of syncope which determines the management strategy clinically.According to 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope,those with syncope are classified as being at short-or long-term risk. Different from previous versions,factors such as male,age,tumor,cerebrovascular diseases,diabetes,high CHADS-2 scores and renal function are also included in the risk stratification this time. In 2018 ESC guidelines for the diagnosis and management of syncope,patients with syncope are labelled as high risk and low risk ones according to medical history,physical symptom and supplementary examination result. High risk patients are suggested actively accepting examination and treatment while low risk patients are mainly given proper patient education,advices for changing lifestyles and physiotherapy.

关 键 词：晕厥 危险因素 猝死 预后 

分 类 号：R540.4[医药卫生—心血管疾病]