Can I, Cytron J, Jhanjee R, Nguyen J, Benditt D G
Department of Medicine, Cardiovascular Division, Cardiac Arrhythmia Center, University of Minnesota Medical School Minneapolis, MN, USA.
Minerva Med. 2009 Aug;100(4):275-92.
Syncope is a syndrome characterized by a relatively sudden, temporary and self-terminating loss of consciousness; the causes may vary, but they have in common a temporary inadequacy of cerebral nutrient flow, usually due to a fall in systemic arterial pressure. However, while syncope is a common problem, it is only one explanation for episodic transient loss of consciousness (TLOC). Consequently, diagnostic evaluation should start with a broad consideration of real or seemingly real TLOC. Among those patients in whom TLOC is deemed to be due to ''true syncope'', the focus may then reasonably turn to assessing the various possible causes; in this regard, the neurally-mediated syncope syndromes are among the most frequently encountered. There are three common variations: vasovagal syncope (often termed the ''common'' faint), carotid sinus syndrome, and the so-called ''situational faints''. Defining whether the cause is due to a neurally-mediated reflex relies heavily on careful history taking and selected testing (e.g., tilt-test, carotid massage). These steps are important. Despite the fact that neurally-mediated faints are usually relatively benign from a mortality perspective, they are nevertheless only infrequently an isolated event; neurally-mediated syncope tends to recur, and physical injury resulting from falls or accidents, diminished quality-of-life, and possible restriction from employment or avocation are real concerns. Consequently, defining the specific form and developing an effective treatment strategy are crucial. In every case the goal should be to determine the cause of syncope with sufficient confidence to provide patients and family members with a reliable assessment of prognosis, recurrence risk, and treatment options.
晕厥是一种以相对突然、暂时且自行终止的意识丧失为特征的综合征；其病因可能各异，但通常因体循环动脉压下降导致脑营养物质供应暂时不足这一点是共同的。然而，虽然晕厥是一个常见问题，但它只是发作性短暂意识丧失（TLOC）的一种解释。因此，诊断评估应从对真实或看似真实的TLOC进行广泛考虑开始。在那些TLOC被认为是由“真性晕厥”引起的患者中，重点可合理转向评估各种可能的病因；在这方面，神经介导的晕厥综合征是最常遇到的病因之一。有三种常见类型：血管迷走性晕厥（常被称为“普通”晕厥）、颈动脉窦综合征和所谓的“情境性晕厥”。确定病因是否由神经介导的反射引起在很大程度上依赖于仔细的病史采集和特定的检查（如倾斜试验、颈动脉按摩）。这些步骤很重要。尽管从死亡率角度来看，神经介导的晕厥通常相对良性，但它们很少是孤立事件；神经介导的晕厥往往会复发，跌倒或事故导致的身体损伤、生活质量下降以及可能的就业或业余爱好受限都是实际问题。因此，确定具体类型并制定有效的治疗策略至关重要。在每种情况下，目标都应该是有足够把握地确定晕厥的病因，以便为患者及其家属提供关于预后、复发风险和治疗选择的可靠评估。
