Department of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Clin Cardiol. 2011 Apr;34(4):222-5. doi: 10.1002/clc.20879.
Complex regional pain syndrome (CRPS) is a debilitating pain syndrome characterized clinically by severe pain along with signs and symptoms of autonomic dysfunction. Presyncope and syncope are common in these patients. The purpose of this study was to investigate the cause of these symptoms in these patients.
Patients with CRPS are more prone to presyncope and syncope as evidenced by head-up tilt table testing (HUTT).
Patients with CRPS underwent a complete cardiac evaluation that included a 12-lead electrocardiogram, 2-dimensional echocardiography, 24-hour Holter monitoring, and HUTT.
Seventy-four patients with CRPS were evaluated. Eight CRPS patients (10%) could not complete a HUTT due to pain. Of the 66 CRPS patients who completed a HUTT, 15 (37.9%) reported pretest symptoms of presyncope or syncope. Twenty-eight CRPS patients (42.4%) had a positive HUTT. CRPS patients with lower limb involvement were more likely to have vasovagal syncope or orthostasis on HUTT than those with upper extremity or total body involvement (12 of 18 [67%] vs 16 of 48 [33%]; P = 0.015).
Syncope is common in patients with CRPS, especially with lower limb involvement. Autonomic dysregulation of the lower extremities leads to impaired sympathetic vasoconstriction and venous pooling, which can predispose these patients to syncope. Physician awareness of this syndrome will lead to improved recognition and treatment of their symptoms of presyncope or syncope.
复杂性区域疼痛综合征（CRPS）是一种使人虚弱的疼痛综合征，其临床特征为严重疼痛以及自主神经功能障碍的迹象和症状。这些患者常出现晕厥前期和晕厥。本研究的目的是调查这些患者出现这些症状的原因。
CRPS 患者更易出现晕厥前期和晕厥，这可通过直立倾斜试验（HUTT）得到证明。
CRPS 患者接受了全面的心脏评估，包括 12 导联心电图、二维超声心动图、24 小时动态心电图监测和 HUTT。
共评估了 74 例 CRPS 患者。8 例 CRPS 患者（10%）因疼痛无法完成 HUTT。在完成 HUTT 的 66 例 CRPS 患者中，15 例（37.9%）报告有晕厥前期或晕厥的症状。28 例 CRPS 患者（42.4%）HUTT 阳性。下肢受累的 CRPS 患者比上肢或全身受累的患者更易出现血管迷走性晕厥或直立性低血压（18 例中有 12 例 [67%] vs 48 例中有 16 例 [33%]；P=0.015）。
晕厥在 CRPS 患者中很常见，尤其是下肢受累的患者。下肢自主神经调节异常导致交感神经血管收缩和静脉淤积受损，这会使这些患者容易发生晕厥。医生对这种综合征的认识将提高对其晕厥前期或晕厥症状的识别和治疗。
