Allan Louise, Johns Emma, Doshi Mira, Anne Kenny Rose, Newton Julia L
Cardiovascular Investigation Unit, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK.
Europace. 2004 May;6(3):192-8. doi: 10.1016/j.eupc.2004.01.003.
Defaecation syncope is defined as blacking out at, or around, the time of defaecation. It is associated with increased mortality; however, patients rarely voluntarily report symptoms. We have examined autonomic function in a cohort of patients with defaecation syncope.
We prospectively identified all subjects referred to our unit with symptoms of defaecation syncope or presyncope on direct questioning. All subjects had autonomic function tests using beat to beat blood pressure measurement synchronized with R-R interval allowing real time assessment of autonomic function.
Seven patients were identified who presented with defaecation syncope. Compared with age and sex matched controls, subjects had abnormalities of both sympathetic and parasympathetic autonomic function consistent with mild-moderate autonomic failure. On specific intervention syncope stopped in all subjects: 3 had culprit medication withdrawn, 3 received medication to increase blood pressure and 1 in whom cardioinhibition was demonstrated improved with permanent pacemaker insertion. Two subjects who had colonoscopy had profound haemodynamic changes during the procedure associated with syncope.
Symptoms of syncope on defaecation are associated with autonomic failure. With appropriate therapeutic intervention our subjects all improved.
排便性晕厥定义为在排便时或排便前后出现晕厥。它与死亡率增加有关；然而，患者很少主动报告症状。我们对一组排便性晕厥患者的自主神经功能进行了检查。
我们通过直接询问前瞻性地确定了所有因排便性晕厥或晕厥前症状转诊至我们科室的受试者。所有受试者均进行了自主神经功能测试，使用与R-R间期同步的逐搏血压测量来实时评估自主神经功能。
确定了7例出现排便性晕厥的患者。与年龄和性别匹配的对照组相比，受试者的交感神经和副交感神经自主神经功能均异常，符合轻度至中度自主神经功能衰竭。经过特定干预，所有受试者的晕厥均停止：3例停用了可疑药物，3例接受了升压药物治疗，1例经证实存在心脏抑制的患者通过植入永久起搏器病情改善。2例接受结肠镜检查的受试者在检查过程中出现了与晕厥相关的严重血流动力学变化。
排便时晕厥症状与自主神经功能衰竭有关。通过适当的治疗干预，我们的受试者均有改善。
