Martin-Gonzalez R, Salas-Tomas M C, Monge-Argiles J A
Hospital Santa Maria del Rosell, 30203 Cartagena, Espana.
Rev Neurol. 2006;43(8):461-5.
According to the current literature on the subject, patients with syncope suffer a dysfunction of the autonomic nervous system (ANS). Yet few studies offer a clear explanation of this dysfunction. Moreover, the evaluation of cardiovascular reflexes is a simple, useful method of studying the functional status of the ANS. This work was designed to evaluate the existence of dysautonomia in syncope patients by means of the autonomic cardiovascular stimulation tests; it has been the most comprehensive of those published to date.
We studied 170 healthy volunteers and 188 patients with syncopes in the previous months, paired by age and sex. Cardiovascular stimulation tests were conducted, in accordance with Ewing and Clark's methodology, together with the cold test. A rating scale was included to evaluate the symptoms related to ANS involvement.
Syncope patients display lower reactivity in tests involving cardiovascular stimulation of the ANS, regardless of whether they are taken individually or as a whole (67% in patients and 39% in controls) (p = 0.0001), except in the cold test. They also show an increase in the clinical symptoms of an autonomic origin (2.82 +/- 0.17) with respect to control subjects (0.78 +/- 0.09) (p = 0.0001).
Our syncope patients have a dysautonomia that appears as a sympathetic and parasympathetic hypofunction. These findings confirm the value of autonomic cardiovascular stimulation tests in the study of these patients. Moreover, the search for other symptoms of autonomic involvement can be a great aid in evaluating this pathology.
根据目前关于该主题的文献，晕厥患者存在自主神经系统（ANS）功能障碍。然而，很少有研究能对这种功能障碍给出清晰的解释。此外，心血管反射评估是研究ANS功能状态的一种简单而有用的方法。本研究旨在通过自主心血管刺激试验评估晕厥患者中自主神经功能障碍的存在情况；这是迄今为止已发表的研究中最为全面的一项。
我们研究了170名健康志愿者以及188名在前几个月有过晕厥发作的患者，按照年龄和性别进行配对。根据尤因和克拉克的方法，连同冷试验一起进行心血管刺激试验。纳入了一个评分量表来评估与ANS受累相关的症状。
晕厥患者在涉及ANS心血管刺激的试验中表现出较低的反应性，无论这些试验是单独进行还是综合进行（患者为67%，对照组为39%）（p = 0.0001），冷试验除外。相对于对照组受试者（0.78±0.09），他们自主神经源性的临床症状也有所增加（2.82±0.17）（p = 0.0001）。
我们的晕厥患者存在自主神经功能障碍，表现为交感神经和副交感神经功能减退。这些发现证实了自主心血管刺激试验在研究这些患者中的价值。此外，寻找自主神经受累的其他症状对评估这种病理情况可能有很大帮助。
