全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...
-  2018 

血管迷走性晕厥患者直立倾斜试验中自主神经活性的变化 Autonomic Nervous Activity Changes During the Head-up Tilt Table Test in Patients with Vasovagal Syncope

Keywords: 血管迷走性晕厥,直立倾斜试验,自主神经活性

Full-Text   Cite this paper   Add to My Lib

Abstract:

目的:探究血管迷走性晕厥(VVS)患者在直立倾斜试验中自主神经活性的变化。方法:53例不明原因、反复发作晕厥的患者,排除器质性疾病和代谢性疾病引起的晕厥后行直立倾斜试验,观察有无阳性反应。倾斜过程中记录动态心电图、血压和心率,并分析心率变异性频域指标:低频标准化值(LFnorm)、高频标准化值(HFnorm)和低高频比值(LF/HF),以及QT动态性指标:QTe/RR斜率和QTp/RR斜率。结果:53例患者均行硝酸甘油激发的倾斜试验,其中23例结果阳性,心脏抑制型1例,占4.3%,血管抑制型6例,占26.1%,混合型16例,占69.6%。在硝酸甘油激发的试验阶段,阳性组LFnorm显著低于基础试验阶段(P<0.05),HFnorm呈上升趋势;而阴性组与基础试验阶段相比,LFnorm、HFnorm及LF/HF均无显著变化(P>0.05)。在服用硝酸甘油后,阴性组的QTe/RR斜率、QTp/RR斜率较之前均显著升高(P<0.05),而阳性组无显著差异。将阴性组以50岁为界,按年龄分为两个亚组,50岁以上组在服用硝酸甘油前、后的心率变异性HF、LF/HF有显著差异(P<0.05),而50岁以下组无明显变化。结论:直立倾斜试验中,交感神经兴奋占主导突然转变为迷走神经过度兴奋是VVS发生的重要机制。心率变异性频域指标和QT动态性指标对于VVS的辅助诊断可能具有一定的参考价值

References

[1]  许岭平,陈剑辉,王阿利,等.177例血管迷走性晕厥的临床特征及治疗转归[J].中国心脏起搏与电生理杂志,2011,25(4):334-336.Xu LP,Chen JH,Wang AL,et al.The clinical features and treatment outcome of 177patients with vasovagal syncope[J].Chin J Card Pac Electrophysiol,2011,25(4):334-336.
[2]  Laitinen T,Niskanen L,Geelen G,et al.Age dependency of cardiovascular autonomic responses to head-up tilt in healthy subjects[J].J Appl Physiol,2004,96(6):2 333-2 340.
[3]  Kenny RA,Ingram A,Bayliss J,et al.Head-up tilt:a useful tool for investigating unexplained syncope[J].Lancet,1986,20(4):1 352-1 355.
[4]  Fenton AM,Hammill SC,Rea RF,et al.Vasovagal syncope[J].Ann Intern Med,2000,133:714-725.
[5]  刘俊,刘悦,卢国英,等.对拟诊血管迷走性晕厥患者进行直立倾斜试验的时程[J].中华心血管病杂志,2011,39(6):494-496.Liu J,Liu Y,Lu GY,et al.Timing of positive headup tilt test for patients with suspected vasovagal syncope[J].Chin J Cardiol,2011,39(6):494-496.
[6]  邓次妮,吴杰,沈潞华,等.硝酸甘油激发的倾斜试验在血管迷走性晕厥中的应用[J].心肺血管病杂志,2006,25(2):68-74.Deng CN,Wu J,Shen LH,et al.Value of nitroglycerininduced tilt-table testing in patients with vasovagal syncope[J].Journal of Cardiovascular and Pulmonary Diseases,2006,25(2):68-74.
[7]  姜雪,刘悦,刘俊,等.年龄和性别对直立倾斜试验诊断血管迷走性晕厥结果的影响[J].中国循环杂志,2014,29(9):706-709.Jiang X,Liu Y,Liu J,et al.Effect of age and gender on head-up tilt test for diagnosing the patients with suspected vasovagal syncope[J].Chinese Cirulation Journal,2014,29(9):706-709.
[8]  Xha3t O,Argacha JF,Pathak A,et al.Sympathoexcitation increases the QT/RR slope in healthy men[J].J Cardiovasc Electrophysiol,2008,19(2):178-184.
[9]  王松云,鲁志兵,赵劲波,等.两种倾斜试验诊断血管迷走性晕厥的Meta分析[J].中国循证心血管医学杂志,2013,5(2):121-126.Wang SY,Lu ZB,Zhao JB,et al.A Meta-analysis on diagnosis of vasovagal syncope with two kinds of tilt table tests[J].Chin J Evid Based Cardiovasc Med,2013,5(2):121-126.
[10]  任自文,吴宁,陈孟扬,等.倾斜试验用于诊断血管迷走性晕厥的建议[J].中华心血管病杂志,1998,26(5):325-326.Ren ZW,Wu N,Chen MY,et al.Recommendations for tilt table tests for diagonosis of vasovagal syncope[J].Chin J Cardiol,1998,26(5):325-326.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133