From the Department of Cardiology, Arrhythmologic Center, Ospedali del Tigullio, Lavagna, Italy (D.S., R.M., D.O., A.S., F.C., P.D., M.B.); and Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (W.W.).
Circ Arrhythm Electrophysiol. 2014 Jun;7(3):505-10. doi: 10.1161/CIRCEP.113.001093. Epub 2014 Apr 24.
Assessment of the vasodepressor reflex in carotid sinus syndrome is influenced by the method of execution of the carotid sinus massage and the coexistence of the cardioinhibitory reflex.
Carotid sinus massage reproduced spontaneous symptoms in 164 patients in the presence of hypotension or bradycardia (method of symptoms). When an asystolic pause was induced, the vasodepressor reflex was reassessed after suppression of the asystolic reflex by means of 0.02 mg/kg IV atropine. An isolated vasodepressor form was found in 32 (20%) patients, who had lowest systolic blood pressure (SBP) of 65±15 mm Hg. Of these, only 21 (66%) patients had an SBP fall ≥50 mm Hg, which is the universally accepted cut-off value for the diagnosis of the vasodepressor form. Conversely, a lowest SBP value of ≤85 mm Hg (corresponding to the fifth percentile) detected 97% of vasodepressor patients, but was also present in 84% of the 132 patients with an asystolic reflex. These latter patients had both asystole ≥3 s (mean 7.6±2.2 s) and SBP fall to 63±22 mm Hg: in 46 (28%) patients, symptoms persisted after atropine (mixed form), in the remaining 86 (52%) patients, symptoms did not (cardioinhibitory form) persist.
The current definition of ≥50 mm Hg SBP fall failed to identify one third of patients with isolated vasodepressor form. A cut-off value of symptomatic SBP of ≤85 mm Hg seems more appropriate, but it is unable to identify cardioinhibitory forms. In asystolic forms, atropine testing is able to distinguish a cardioinhibitory form from a mixed form.
颈动脉窦综合征患者的压力感受性反射评估受到颈动脉窦按摩执行方法和心脏抑制反射并存的影响。
颈动脉窦按摩在 164 例患者中复制了自发性症状，这些患者同时存在低血压或心动过缓（症状方法）。当出现停搏时，通过静脉注射 0.02 毫克/千克的阿托品抑制停搏反射，重新评估血管减压反射。在 32 例（20%）患者中发现了孤立的血管减压形式，这些患者的收缩压（SBP）最低为 65±15mmHg。其中，只有 21 例（66%）患者的 SBP 下降≥50mmHg，这是诊断血管减压形式的通用截止值。相反，最低 SBP 值≤85mmHg（对应第五个百分位）检测到 97%的血管减压患者，但也存在于 132 例具有停搏反射的患者中的 84%。这些患者的停搏时间≥3s（平均 7.6±2.2s），且 SBP 下降至 63±22mmHg：在 46 例（28%）患者中，阿托品后症状持续（混合形式），在其余 86 例（52%）患者中，症状不再持续（心脏抑制形式）。
目前≥50mmHg 的 SBP 下降标准未能识别三分之一的孤立性血管减压形式患者。症状性 SBP 的截止值≤85mmHg 似乎更为合适，但无法识别心脏抑制形式。在停搏形式中，阿托品试验能够区分心脏抑制形式和混合形式。
