倾斜试验加异丙肾上腺素静滴用于血管迷走神经性晕厥的诊断Utility of Isoproterenol-Tilt Table Testing in The Diagnosis of Vagovagal Syncope
杨兰,胡大一,汪丽蕙,魏庆民
摘要(Abstract)：
本文研究倾斜体位加异丙肾上腺素静滴诱发血管迷走神经性晕厥,12例有晕厥史的病人中9例诱发出晕厥,而6例正常人无1例阳性.晕厥发作时伴有血压明显下降;试验结束时,阳性组和对照组收缩压比较为10±1.2kPa(75±9mmHg)vs13.3±0.65kPa(100±5mmHg)(P<.001),舒张压力5.3±1.3kPa(40±10mmHg)vs8.3±0.4kPa(62±3mmHg)(P<0.001),阴性组和对照组相比无差异;晕厥发生在倾斜后7±3.2分钟,晕厥时血压处于最低点即收缩压由倾斜开始时的14.9±1.9kPa(112±14mmHg)降到10±1.2kPa(75±9mmHg)(P<0.001),舒张压由10±1,2kPa(72±9mmHg)降至5.3±1.3kPa(40±10mmHg)(P<0.001);阳性组中有2例低血压同时伴心动过缓.倾斜体位加异丙肾上腺素静滴方法用于诊断血管迷走神经性晕厥简单、安全、且为非创伤性手段,对临床诊治有一定帮助.
关键词(KeyWords)： 血管迷走神经性晕厥;倾斜试验;异丙肾上腺素
基金项目(Foundation):
作者(Author): 杨兰,胡大一,汪丽蕙,魏庆民
参考文献(References)：
- [1] Wayne HH.Syncope,physiologic consideration and analysis of the clinical characteristics in 510 patients.Am J Med 1961,30:418
- [2] Stephen FS,Steven DN,Harisios B,et at.Syncope.In: Robert A,(ed).Current Problems in Cardiology.Mosby Year Book Inc.Vol 17(4) ,1992． 223～224
- [3] Glick G,Yu PN:Hemodynamic changes during spontaneous vasovagal reactions.Am J Med 1963,34:42
- [4] Fitzpatrick AP,Williams T.Theodorakis G,et al.Echocardiographic and endocrine changes during vasovagal syncope,PACE 1989;12(part):1279
- [5] Almquist A,Goldenberg IF,Milstein S,et al.Provocation of bradycardia and hypotension by isoproterenol and upright posture in patients with unexplained syncope.N Engl J Med 1989;302:346
- [6] Sheldon R.Killam S.Methodology of isoproterenoltilt table testing in paients with syncope.JACC 1992． 19:773
- [7] Chen XCH,Chen MY,Remole S,et al.Reproducibility of head up tilt-table testing for eliciting susceptibility to neurally mediated syncope in petients without structural heart disease.Am J Cardiol 1992,69:755
- [8] weissler AM,Leonard JJ,warren JV.The hemodynamic effects of isoproterenol in man.J Zab Clin Med 1959． 55． 921
- [9] Goldenberg IF,Almquist A,Dunbar DN.et al.Prevention of neurally-mediated syncope by selective beca I adrenoreceptor?blockaoe.abstract.Circulation 1987;76(Suppl Ⅳ).155