Center for Emergency Medicine, Skåne University Hospital, Malmö, Sweden.
Europace. 2010 Sep;12(9):1322-8. doi: 10.1093/europace/euq168. Epub 2010 May 27.
To investigate whether a systematic approach to unexplained syncopal attacks based on the European Society of Cardiology guidelines would improve the diagnostic and therapeutic outcomes.
Patients presenting with transient loss of consciousness to the Emergency Department of Skåne University Hospital in Malmö were registered by triage staff. Those with established cardiac, neurological, or other definite aetiology and those with advanced dementia were excluded. The remaining patients were offered evaluation based on an expanded head-up tilt test protocol, which included carotid sinus massage, and nitroglycerine challenge if needed. Out of 201 patients registered over a period of 6 months, 129 (64.2%) were found to be eligible; of these, 101 (38.6% men, mean age 66.3 +/- 18.4 years) decided to participate in the study. Head-up tilt test allowed diagnoses in 91 cases (90.1%). Vasovagal syncope (VVS) was detected in 45, carotid sinus hypersensitivity (CSH) in 27, and orthostatic hypotension (OH) in 51 patients. Twelve patients with VVS and 15 with CSH also had OH, whereas 25 were diagnosed with OH only. In a multivariate logistic regression, OH was independently associated with age [OR (per year): 1.05, 95% CI 1.02-1.08, P = 0.001], history of hypertension (2.73, 1.05-7.09, P = 0.039), lowered estimated glomerular filtration rate (per 10 mL/min/1.73 m(2): 1.17, 1.01-1.33, P = 0.032), use of loop diuretics (10.44, 1.22-89.08, P = 0.032), and calcium-channel blockers (5.29, 1.03-27.14, P = 0.046), while CSH with age [(per year) 1.12, 1.05-1.19, P < 0.001), use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (4.46, 1.22-16.24, P = 0.023), and nitrates (27.88, 1.99-389.81, P = 0.013).
A systematic approach to patients presenting with unexplained syncopal attacks considerably increased diagnostic efficacy and accuracy. Potential syncope diagnoses have a tendency to overlap and show diversity in demographic, anamnestic, and pharmacological determinants.
研究基于欧洲心脏病学会指南的不明原因晕厥发作的系统方法是否会改善诊断和治疗结果。
通过分诊人员对在马尔默斯科讷大学医院急诊科出现短暂意识丧失的患者进行登记。那些有明确的心脏、神经或其他确定病因的患者以及有晚期痴呆的患者被排除在外。对其余患者进行了基于扩展的头高位倾斜试验方案的评估，如果需要，还进行了颈动脉窦按摩和硝酸甘油挑战。在 6 个月的时间内登记了 201 名患者，其中 129 名（38.6%为男性，平均年龄 66.3 +/- 18.4 岁）符合条件；其中 101 名（90.1%）决定参与研究。头高位倾斜试验可在 91 例中做出诊断（90.1%）。检测到血管迷走性晕厥（VVS）45 例，颈动脉窦过敏（CSH）27 例，体位性低血压（OH）51 例。12 例 VVS 和 15 例 CSH 患者也有 OH，而 25 例仅诊断为 OH。在多变量逻辑回归中，OH 与年龄独立相关[每增加 1 年的比值比（OR）：1.05，95%置信区间（CI）为 1.02-1.08，P = 0.001]，高血压病史（2.73，1.05-7.09，P = 0.039），估算肾小球滤过率降低（每增加 10 mL/min/1.73 m(2)：1.17，1.01-1.33，P = 0.032），使用袢利尿剂（10.44，1.22-89.08，P = 0.032）和钙通道阻滞剂（5.29，1.03-27.14，P = 0.046），而 CSH 与年龄有关[每增加 1 年的比值比（OR）：1.12，1.05-1.19，P < 0.001），使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（4.46，1.22-16.24，P = 0.023）和硝酸盐（27.88，1.99-389.81，P = 0.013）。
对出现不明原因晕厥发作的患者进行系统评估可显著提高诊断效果和准确性。潜在的晕厥诊断倾向于重叠，并在人口统计学、病史和药理学决定因素方面表现出多样性。
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