Tausche P
Z Gesamte Inn Med. 1978 Sep 15;33(18):656-60.
100 patients with peripheral arteriosclerotic obstructive disease were examined for latent bradycardic disturbances of the rhythm by means of the pressure experiment on the carotid sinus under screening conditions. 57% of the arteriosclerotics had sinus-auricular or atrioventricular blockings, 67% of them an asystole over 3 s. In 84% of the cases this asystole was conditioned by a sinus-auricular block. In a comparative group of the same age only a retardation of the sinus rhythm was found. An asystole over 3 s in a pressure experiment on the carotid sinus refers to an endangering by Morgagni-Adams-Stokes-attacks, since the substitution pacemaker in form of the secondary stimulation formation system insufficiency compensatorily steps into the breach. Particularly endangered seem to be patients with additionally bradycardizing medicaments (glycosides, antihypertensive drugs, beta-receptor blockers, antiarrhythmic drugs) which frequently and combined are prescribed in arteriosclerotics with hypertensive cardiac disease. In synopsis with anamnesis, findings of the examinations and the ECG-analysis with and without pressure experiment on the carotid sinus can be decided on the actual therapy up to the pacemaker implantation. The method proved to be suitable as screening and preliminary examination before the prescription of the medicaments mentioned above when performed correctly and the contraindication was taken into consideration. It is to be discussed whether before recommendation of the broad application of the pressure on the carotid sinus without possibility of reanimation a phase of another testing should precede.
对100例周围动脉硬化闭塞性疾病患者在筛查条件下通过对颈动脉窦进行压力试验来检查有无潜在的缓慢性心律失常。57%的动脉硬化患者存在窦房或房室传导阻滞,其中67%有超过3秒的心脏停搏。在84%的病例中,这种心脏停搏是由窦房阻滞引起的。在相同年龄的对照组中,仅发现窦性心律减慢。在颈动脉窦压力试验中出现超过3秒的心脏停搏意味着有莫加尼 - 亚当斯 - 斯托克斯发作的危险,因为作为次级刺激形成系统功能不全形式的替代起搏器会代偿性地介入。似乎特别危险的是那些还服用使心率减慢药物(糖苷类、抗高血压药物、β受体阻滞剂、抗心律失常药物)的患者,这些药物在患有高血压性心脏病的动脉硬化患者中经常联合使用。结合病史、检查结果以及有无颈动脉窦压力试验的心电图分析,可以确定直至起搏器植入的实际治疗方案。当正确进行且考虑到禁忌证时,该方法被证明适合作为上述药物处方前的筛查和初步检查。在推荐广泛应用颈动脉窦按压且无复苏可能性之前是否应该先进行另一阶段的测试,这一点值得讨论。