Tan M P, Duncan G W, Parry S W
Institute for Ageing and Health, Newcastle University, Newcastle, UK.
Minerva Med. 2009 Aug;100(4):329-38.
Vasovagal syncope (VVS) is the commonest cause of syncope accounting for up to 60% of all cases. The head-up tilt-table test (HUTT) was first described as a diagnostic test for VVS in 1986 and is now in widespread use as a research and diagnostic tool. Vasovagal syncope was previously thought to be confined to younger patients but with the introduction of HUTT, it is now being diagnosed with greater frequency in the elderly. Research into the physiological changes in susceptible individuals during HUTT has greatly increased our understanding of the pathophysiological processes underlying VVS; in particular, the hypotensive response during VVS is associated with sympathetic withdrawal rather than bradycardia alone. Various provocation agents, including nitrates, isoprotenerol and lower body negative pressure have been described to improve the diagnostic yield of the HUTT. Glyceryl trinitrate is now routinely administered during HUTTs. Individuals with typical presentations and infrequent episodes do not require investigation with HUTT as history alone is often diagnostic. The head-up tilt-table test is, however, required with atypical features, seizure activity, occupational issues, and is more likely to be required in older patients. The practicalities of conducting the HUTT and limitations of HUTTs are also discussed.
血管迷走性晕厥（VVS）是晕厥最常见的原因，占所有病例的60%。头高位倾斜试验（HUTT）于1986年首次被描述为VVS的诊断试验，现在作为一种研究和诊断工具被广泛使用。血管迷走性晕厥以前被认为仅限于年轻患者，但随着HUTT的引入，现在在老年人中被诊断出的频率更高。对易感个体在HUTT期间生理变化的研究极大地增进了我们对VVS潜在病理生理过程的理解；特别是，VVS期间的低血压反应与交感神经撤退有关，而不仅仅是心动过缓。已经描述了各种激发剂，包括硝酸盐、异丙肾上腺素和下体负压，以提高HUTT的诊断率。硝酸甘油现在在HUTT期间常规使用。具有典型表现且发作不频繁的个体不需要进行HUTT检查，因为仅病史往往就具有诊断价值。然而，具有非典型特征、癫痫活动、职业问题的个体需要进行头高位倾斜试验，老年患者更有可能需要进行该试验。还讨论了进行HUTT的实际操作和HUTT的局限性。
