摘要
目的研究不明原因晕厥患者在直立倾斜试验中的血流动力学改变及其年龄、性别与血流动力学改变的相关性。方法93例不明原因晕厥患者进行基础倾斜试验及硝酸甘油激发试验，持续监测、记录心电、血压变化。分析患者的基本特征及其在倾斜试验早期和倾斜试验过程中的血流动力学反应。结果93例患者均可耐受及完成试验。阳性反应52例（55．9％），其中混合型18例（34．6％）、血管抑制型30例（57．7％）、心脏抑制型4例（7．7％）；阴性反应41例（44．1％），其中正常反应29例（70．7％）、直立体位性心动过速综合征（POTS）4例（9．8％）自主神经反应障碍8例（19．5％），直立位低血压0例。将所有病人按年龄分为3组：A组：≤30岁；B组：31～50岁；C组：≥51岁，随年龄增长，出现变时性不良的可能性增加（OR 0．94095％ CI 0．906-0．975 P=0．001），而随年龄减小，出现心率过度增加的可能性增加（OR 1．10695％ CI 1．034-1．182 P=0．003）。高龄与自主神经反应障碍和混合型血管迷走性晕厥的发生相关，而低龄与血管抑制型血管迷走性晕厥的发生相关（P〈0．01）。性别与倾斜试验的阴性及阳性结果差异元统计学意义（P=0.12）。结论倾斜试验中，年轻人主要表现为心率过度增加，而老年人则多为心率变化不明显。对倾斜试验中血流动力学变化的观察分析、研究年龄性别与血流动力学反应的关系，对明确晕厥原因，选择相应治疗方案具有重要意义。
Objectives To study different hemodynamic patterns displayed over the course of head-up tilt testing in unexplained syncope patients and to determine whether there are age-related and/or gender-related differences in hemodynamic patterns. Methods Ninety-three consecutive syneopal patients were studied using a two-stage tilt protocol with glyceryl trinitrate （GTN）provocation. The baseline characteristics and hemodynamic responses during both early and lib-induced collapse were analyzed. Results All patients were able to tolerate tilt testing. 52 （55.9%） of 93 unexplained syncope patients displayed hemodynamic pattern of vasovagal response, among which 18 （34.6%） displayed pattern of mixed vasovagal response, 4 （9.8%） cardioinhabitory re- sponse and 30 （57.7%） vasodepressor response. Of the 41 （44.1%） negative patients, 29 （70.7%） displayed hemodynamic pattern of normal hemodymanic response, 4 （9.8%） postural orthostatic taehycardia syndrome, 8 （19.5%） dysautonomie response, Age was independently associated with distinct responses during tilt. Chronotropic incompetence was predicted by increasing age （odd ratio [OR]0.940 95% CI 0.906-0.975 P=0.001）, Younger age predicated an excessive heart rate rise （OR 1.106 95% CI 1.034-1.182 P=0.003）. Gender has no significant effect on hemodynamic response during tilt. Conclusions There appear to be distinct pathophysiologies underlying vasovagal syncope in different age groups over the course of head-up tilt testing. Young people appear to have excessive cardiac and autonomic responses to stress, whereas older patients appear to have a more generalized cardiovascular decline, with attenuated cardiac and autonomic responses to stress.
出处
《中华心律失常学杂志》
2006年第1期42-46,共5页
Chinese Journal of Cardiac Arrhythmias
