Vallejo Maite, Hermosillo Antonio G, Márquez Manlio F, Urquidez Alma K, Sotomayor Arturo, Salas Elizabeth, Cárdenas Manuel
Subdirección de Sociomedicina, Instituto Nacional de Cardiología, Ignacio Chávez, México, DF, México.
Arch Med Res. 2007 Jul;38(5):579-83. doi: 10.1016/j.arcmed.2007.03.003.
Studies to assess the value of clinical symptoms to predict the head-up tilt test (HUT) outcome in patients with suspicion of vasovagal syncope have shown controversial results. We undertook this study to compare the frequency of symptoms between subjects with and without history of syncope, its association with syncopal spells in those with a history of syncope and positive or negative HUT, and to identify clinical predictors of HUT outcome. Sixty seven subjects with a history of unexplained syncope and 26 subjects without a history of syncope were interviewed using a structured questionnaire before undergoing HUT, which was performed first in a passive phase and, if negative, was repeated with pharmacological challenge using 5 mg of sublingual isosorbide. Questionnaire included the 16 symptoms most frequently reported in previous studies. Only five symptoms were reported more frequently by subjects with history of syncope in comparison with subjects without it: visual blurring, dysesthesia, sighing dyspnea, tremor in fingers, and diaphoresis. Comparison of symptom frequency between patients with history of syncope and positive or negative HUT revealed that only two were significantly different: nausea and hot flashes. However, a detailed analysis of the data indicates that only hot flashes occurring just before the syncope were more common in those with a positive HUT. Although some symptoms were found more frequently in patients with a history of syncope than in those without it, the use of a structured questionnaire in the group of patients failed to predict the outcome of the HUT.
评估临床症状对疑似血管迷走性晕厥患者预测直立倾斜试验（HUT）结果的价值的研究结果存在争议。我们开展这项研究，比较有晕厥病史和无晕厥病史的受试者之间症状的发生频率、有晕厥病史且HUT结果为阳性或阴性的受试者中症状与晕厥发作的关联，并确定HUT结果的临床预测因素。67名有不明原因晕厥病史的受试者和26名无晕厥病史的受试者在接受HUT之前使用结构化问卷进行了访谈，HUT首先在被动阶段进行，如果结果为阴性，则使用5毫克舌下含服异山梨酯进行药物激发试验并重复进行。问卷包括先前研究中最常报告的16种症状。与无晕厥病史的受试者相比，有晕厥病史的受试者报告的症状中只有5种更频繁：视力模糊、感觉异常、叹息样呼吸困难、手指震颤和出汗。有晕厥病史且HUT结果为阳性或阴性的患者之间症状发生频率的比较显示，只有两种症状有显著差异：恶心和潮热。然而，对数据的详细分析表明，只有晕厥前出现的潮热在HUT结果为阳性的患者中更常见。虽然发现一些症状在有晕厥病史的患者中比在无晕厥病史的患者中更频繁出现，但在该组患者中使用结构化问卷未能预测HUT的结果。
