Colman N, Nahm K, van Dijk J G, Reitsma J B, Wieling W, Kaufmann H
Dept. of Internal Medicine, Room F4-221, Academic Medical Centre, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
Clin Auton Res. 2004 Oct;14 Suppl 1:37-44. doi: 10.1007/s10286-004-1006-0.
The medical history, in combination with the physical examination and a 12-lead electrocardiogram, plays a key role in the diagnosis and risk stratification of patients with syncope. However, diagnostic clinical criteria are not uniformly applied. In older studies, the diagnostic criteria for vasovagal or reflex syncope often included typical precipitating events and warning symptoms. More recent studies have documented that a variety of unrecognized stressors can trigger reflex syncope and that warning signs and symptoms may be minimal. A characteristic medical history (a trigger and/or prodromi) is enough to diagnose reflex syncope if the risk for a cardiac cause of syncope is low (e. g. patients < 65 yrs, without a history of heart disease and no ECG abnormalities). In elderly subjects with a higher risk of cardiac syncope, the yield of the medical history is lower. However, a prospective study of the value of the medical history for the diagnosis of syncope with long-term follow-up has not been performed.
病史结合体格检查和12导联心电图，在晕厥患者的诊断和风险分层中起着关键作用。然而，诊断性临床标准并未得到统一应用。在早期研究中，血管迷走性或反射性晕厥的诊断标准通常包括典型的诱发事件和预警症状。最近的研究表明，多种未被识别的应激源可触发反射性晕厥，且预警体征和症状可能很轻微。如果晕厥由心脏原因引起的风险较低（例如年龄<65岁、无心脏病史且心电图无异常的患者），典型的病史（诱因和/或前驱症状）足以诊断反射性晕厥。在心脏性晕厥风险较高的老年患者中，病史的诊断价值较低。然而，尚未进行关于病史对晕厥诊断价值的前瞻性长期随访研究。
