Chen Lin Y, Benditt David G, Shen Win-Kuang
Department of Medicine, Cardiovascular Division, National University of Singapore.
Mayo Clin Proc. 2008 Nov;83(11):1280-93. doi: 10.4065/83.11.1280.
Syncope is a clinical syndrome characterized by transient loss of consciousness and postural tone that is most often due to temporary and spontaneously self-terminating global cerebral hypoperfusion. A common presenting problem to health care systems, the management of syncope imposes a considerable socioeconomic burden. Clinical guidelines, such as the European Society of Cardiology Guidelines on Management of Syncope, have helped to streamline its management. In recent years, we have witnessed intensive efforts on many fronts to improve the evaluation process and to explore therapeutic options. For this update, we summarized recent active research in the following areas: the role of the syncope management unit and risk prediction rules in providing high-quality and cost-effective evaluation in the emergency department, the implementation of structured history taking and standardized guideline-based evaluation to improve diagnostic yield, the evolving role of the implantable loop recorder as a diagnostic test for unexplained syncope and for guiding management of neurally mediated syncope, and the shift toward nonpharmacological therapies as mainstay treatment for patients with neurally mediated syncope. Syncope is a multidisciplinary problem; future efforts to address critical issues, including the publication of clinical guidelines, should adopt a multidisciplinary approach.
晕厥是一种临床综合征，其特征为短暂意识丧失和姿势张力丧失，最常见的原因是暂时性且能自发终止的全脑灌注不足。晕厥是医疗系统中常见的就诊问题，其管理带来了相当大的社会经济负担。临床指南，如欧洲心脏病学会晕厥管理指南，有助于简化其管理。近年来，我们看到在多个方面都做出了巨大努力，以改进评估流程并探索治疗方案。在本次更新中，我们总结了以下领域的近期积极研究成果：晕厥管理单元和风险预测规则在急诊科提供高质量且具成本效益评估中的作用；实施结构化病史采集和基于标准化指南的评估以提高诊断率；植入式环路记录仪作为不明原因晕厥诊断测试以及指导神经介导性晕厥管理的作用不断演变；以及向将非药物治疗作为神经介导性晕厥患者主要治疗方法的转变。晕厥是一个多学科问题；未来解决关键问题的努力，包括临床指南的发布，应采用多学科方法。
