起搏器治疗复杂晕厥病例1例  

A Case of Recurrent Syncope Diagnosed by the Implantable Cardiac Monitor

作　　者：蒋金鑫 廖建宁 JIANG Jinxin;LIAO Jianning(Department of Cardiology,Xiamen Chang Gung Hospital,Xiamen Fujian 361028,China)

机构地区：[1]厦门长庚医院心内科,福建厦门361028

出　　处：《中国卫生标准管理》2019年第4期68-71,共4页China Health Standard Management

摘　　要：目的报道心电事件记录仪确诊复杂晕厥病例1例,并结合相关文献,探讨复杂性晕厥的诊断方法及相关治疗。方法回顾性分析我院1例反复晕厥患者的诊治全过程,首先复习外院检查资料,结合入院时临床特点,我院给予有针对性检查、治疗,过程中病情反复,最终予以分析解决。结果心电事件记录仪确诊心动过缓造成晕厥,行起搏器植入术后症状缓解,但仍复发,完善相关检查考虑高迷走张力导致晕厥,予以相应治疗,症状缓解。结论对于反复发作的复杂晕厥,如倾向于心源性晕厥,尽早植入心电事件记录仪有助于尽快明确诊断,给予针对性的治疗。对于反射介导的晕厥,起搏器有助于缓解症状,能否改善预后及避免复发仍需进一步研究。Objective To report a patient with recurrent syncope,establishing the diagnosis by the implantable cardiac monitor(ICM),and review the related literaure,to investigate the evaluation and management of recurrent syncope.Methods A retrospective analysis of the whole process of diagnosis and treatment,including reviewing the datas from other hospital,implanting ICM and pacemaker.Results ICM revealed the mechanism of recurrent syncope was bradycardia.Pacing was associated with a sharp reduction in recurrent syncope.Syncope still recurred.A positive tilt-talble test suggested a predisposition to vasovagal syncope.Conclusion ICM should be implanted early rather than late in the evaluation of unexplained recurrent syncope.The evidence does not support the use of pacing for reflex-mediated syncope beyond patients with recurrent vasovagal syncope and asystole documented by implantable loop recorder.

关 键 词：晕厥 心源性晕厥 反射性晕厥 血管迷走性晕厥 直立倾斜试验 植入式心电事件记录仪 起搏器 病例报告 

分 类 号：R541[医药卫生—心血管疾病]