Laranjo Sérgio, Martins Oliveira Mário, Tavares Cristiano, Geraldes Vera, Santos Sofia, Oliveira Eunice, Ferreira Rui, Rocha Isabel
Instituto de Fisiologia e Unidade de Sistema Nervoso Autónomo, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
Rev Port Cardiol. 2012 Jul-Aug;31(7-8):469-76. doi: 10.1016/j.repc.2012.05.004. Epub 2012 Jun 4.
Neurocardiogenic syncope (NCS) is a common clinical entity resulting from an excessive reflex autonomic response, particularly during orthostatism. Treatment options are controversial and of limited effectiveness. Tilt training (TT) is a promising option to treat these patients. However, its mechanism of action and clinical impact remain unclear.
To characterize hemodynamic and autonomic responses during a TT program in patients with NCS refractory to conventional measures.
We studied 28 patients (50% male, mean age 41±14 years) without structural heart disease, with NCS documented by tilt testing. The TT program included 9 tilt sessions (3 times a week, 30 min) (60° - 6 sessions, 70° - 3 sessions), under ECG and blood pressure monitoring combined with home orthostatic self-training and 10° head-up during sleep. Systolic volume, cardiac output, total peripheral resistance, baroreflex sensitivity and heart-rate variability were computed. Patients were reassessed at 1 month and every 6 months for a maximum of 36 months (24±12 months).
Over the course of the TT program there was a significant increase in total peripheral resistance (1485±225 vs. 1591±187 dyn·s·cm(-5), p<0.05), with a decrease in standard deviation (206±60 vs. 150±42, p<0.05). During follow-up, syncope recurred in five patients (19%), with a significant reduction in the number of episodes (4.0±3.2/patient in the 12 months before TT vs. 1.4±0.8/patient post-TT, p<0.05).
In refractory NCS, TT may be an effective therapeutic option, with long-term benefits. These results appear to be due to an increase in vasoconstrictor reserve combined with a reduction in its variance.
神经心源性晕厥（NCS）是一种常见的临床病症，由过度的反射性自主神经反应引起，尤其是在直立状态下。治疗方案存在争议且效果有限。倾斜训练（TT）是治疗这些患者的一种有前景的选择。然而，其作用机制和临床影响仍不清楚。
描述在传统措施治疗无效的NCS患者进行TT计划期间的血流动力学和自主神经反应。
我们研究了28例无结构性心脏病的患者（50%为男性，平均年龄41±14岁），通过倾斜试验记录有NCS。TT计划包括9次倾斜训练（每周3次，每次30分钟）（60° - 6次训练，70° - 3次训练），在心电图和血压监测下，结合家庭直立位自我训练以及睡眠时头部抬高10°。计算每搏输出量、心输出量、总外周阻力、压力反射敏感性和心率变异性。在1个月时以及之后每6个月对患者进行重新评估，最长评估36个月（24±12个月）。
在TT计划过程中，总外周阻力显著增加（1485±225 vs. 1591±187 dyn·s·cm⁻⁵，p<0.05），标准差降低（206±60 vs. 150±42，p<0.05）。在随访期间，5例患者（19%）再次发生晕厥，发作次数显著减少（TT前12个月每位患者4.0±3.2次 vs. TT后每位患者1.4±0.8次，p<0.05）。
在难治性NCS中，TT可能是一种有效的治疗选择，具有长期益处。这些结果似乎归因于血管收缩储备增加及其变异性降低。
