Schleifer John William, Shen Win-Kuang
Mayo Clinic Arizona, Division of Cardiovascular Diseases , 5777 East Mayo Boulevard, Phoenix, AZ 85054 , USA.
Expert Opin Pharmacother. 2015 Mar;16(4):501-13. doi: 10.1517/14656566.2015.996129. Epub 2014 Dec 23.
Syncope is an abrupt loss of consciousness in response to reduced perfusion to the brain. Neurocardiogenic or vasovagal syncope results from a complex neurologic reflex, and treatments to prevent recurrence attempt to modulate aspects of that reflex.
Pharmacologic treatments for vasovagal syncope address the syncope reflex in multiple ways. Fludrocortisone and sodium chloride increase systemic fluid volume. Midodrine, β blockers and norepinephrine transport inhibitors modulate the sympathetic nervous system. Other treatments for syncope modulate other neurotransmitters or affect heart rate. The most recent trials evaluating established and novel therapies are reviewed.
To reduce recurrence of vasovagal syncope, conservative measures are first line. If these fail to prevent recurrence, the most promising medical therapy includes midodrine. Randomized placebo-controlled data evaluating fludrocortisone, midodrine and β blockers in older patients are awaited. Because of the significance of the placebo effect in this condition, any treatment must be evaluated in a randomized double-blind placebo-controlled trial before being accepted as effective.
晕厥是因大脑灌注减少而突然发生的意识丧失。神经心源性或血管迷走性晕厥由复杂的神经反射引起，预防复发的治疗旨在调节该反射的各个方面。
血管迷走性晕厥的药物治疗通过多种方式作用于晕厥反射。氟氢可的松和氯化钠可增加全身血容量。米多君、β受体阻滞剂和去甲肾上腺素转运抑制剂可调节交感神经系统。晕厥的其他治疗方法可调节其他神经递质或影响心率。本文综述了评估现有疗法和新疗法的最新试验。
为减少血管迷走性晕厥的复发，保守措施是一线治疗方法。如果这些措施未能预防复发，最有前景的药物治疗包括米多君。期待有评估老年患者使用氟氢可的松、米多君和β受体阻滞剂的随机安慰剂对照数据。由于安慰剂效应在这种疾病中的重要性，任何治疗在被认为有效之前都必须在随机双盲安慰剂对照试验中进行评估。
