Kharraziha Isabella, Torabi Parisa, Johansson Madeleine, Sutton Richard, Fedorowski Artur, Hamrefors Viktor
Department of Clinical Sciences, Lund University, 202 13 Malmö, Sweden.
Department of Clinical Physiology, Skåne University Hospital, 214 28 Malmo, Sweden.
J Clin Med. 2022 Jul 25;11(15):4302. doi: 10.3390/jcm11154302.
Age-related physiological impairment increases susceptibility to syncope. We tested the hypotheses that cerebral oxygenation during orthostatic provocation, as well as the level at which syncope occurs, differs according to age. Non-invasive hemodynamic monitoring and cerebral oximetry were applied during a head-up tilt test in 139 patients with vasovagal syncope (mean (SD) 45, (17) years, 60%-female); 121 patients with orthostatic hypotension (61.4 (19.2) years, 49.6%-female); and 82 patients with a negative head-up tilt test (45 (18) years, 61%-female). Group differences in cerebral tissue oxygenation levels and systolic blood pressure were assessed in supine at 3 and 10 min of orthostatic provocation, 30 s before (i.e., presyncopal phase) and during syncope in age groups of <30, 30−60, and >60 years. During the head-up tilt test, cerebral tissue oxygenation at the presyncopal phase decreased with age, both in patients with vasovagal syncope (<30 years: 66.9 ± 6.2, 30−60: 64.5 ± 6.1, >60: 62.2 ± 5.8%; p = 0.009) and orthostatic hypotension (<30: 67.4 ± 4.4, 30−60: 61.6 ± 6.2, >60: 57.5 ± 3.9; p < 0.001). Mean systolic blood pressure at the presyncopal phase did not differ according to age. Cerebral oxygenation prior to syncope in older individuals with vasovagal syncope and orthostatic hypotension is lower compared with younger individuals independently of systolic blood pressure. This suggests that the level of cerebral oxygenation at which syncope is elected is lower in older individuals.
与年龄相关的生理功能损害会增加晕厥易感性。我们检验了以下假设：体位性激发试验期间的脑氧合以及晕厥发生时的水平因年龄而异。对139例血管迷走性晕厥患者（平均（标准差）45（17）岁，60%为女性）、121例体位性低血压患者（61.4（19.2）岁，49.6%为女性）和82例直立倾斜试验结果为阴性的患者（45（18）岁，61%为女性）进行直立倾斜试验期间采用无创血流动力学监测和脑血氧饱和度测定。在年龄小于30岁、30至60岁和大于60岁的年龄组中，于仰卧位、体位性激发试验3分钟和10分钟时、晕厥前30秒（即晕厥前期）以及晕厥期间评估脑组织氧合水平和收缩压的组间差异。在直立倾斜试验期间，血管迷走性晕厥患者（小于30岁：66.9±6.2，30至60岁：64.5±6.1，大于60岁：62.2±5.8%；p = 0.009）和体位性低血压患者（小于30岁：67.4±4.4，30至60岁：61.6±6.2，大于60岁：57.5±3.9；p < 0.001）在晕厥前期的脑组织氧合均随年龄降低。晕厥前期的平均收缩压无年龄差异。血管迷走性晕厥和体位性低血压的老年个体晕厥前的脑氧合低于年轻个体，且与收缩压无关。这表明老年个体发生晕厥时的脑氧合水平较低。
