Bräuninger S, Maas A, Nanke C, Stellwaag M, Uebis S, Lambertz H
Fachbereich Kardiologie, Deutsche Klinik für Diagnostik, Wiesbaden.
Dtsch Med Wochenschr. 1996 Aug 2;121(31-32):971-7. doi: 10.1055/s-2008-1043094.
The cause of syncope remains unclear in half of the cases, even after extensive neurological and cardiological examination. A study was, therefore, undertaken to determine the number of patients with the suspected diagnosis of vasovagal syncope that were confirmed by the tilting table test and how often it required the additional administration of isoprenaline to do so.
A tilting table test was performed on 75 patients (49 men, 26 women; mean age 41 [17-80] years) with syncopes of uncertain cause, previous examinations having failed to discover any neurological or cardiological cause. The test was done with a head-up angle of 60 degrees for 30 min. ECG and arterial blood pressure by indwelling catheter were recorded continuously. If the test was negative, isoprenaline was given intravenously at a rate of 5 micrograms/min during a five-minute period in the horizontal position, followed by 10 minutes at 60 degrees head-up position.
Vasovagal syncope or presyncope was induced in 49 of the 75 patients during the tilting table test, a sensitivity of 65%. But 45% of the tests were positive only with the administration of isoprenaline, i.e. an increase in sensitivity to 81.5%. In 96% of the patients with a positive test there was conformity of symptoms between the induced and the spontaneously occurring syncopes.
The tilting table test is a valuable means of investigating cases of syncope. More than half of the cases of syncope of uncertain cause can be correctly diagnosed classified in this way. The additional use of isoprenaline infusion greatly increases the sensitivity of the method.
即使经过广泛的神经学和心脏病学检查，仍有半数晕厥病例的病因不明。因此，开展了一项研究，以确定疑似血管迷走性晕厥且经倾斜试验确诊的患者数量，以及该试验需要额外使用异丙肾上腺素的频率。
对75例晕厥病因不明且先前检查未发现任何神经学或心脏病学病因的患者（49例男性，26例女性；平均年龄41[17 - 80]岁）进行倾斜试验。试验时头部抬高60度，持续30分钟。通过留置导管持续记录心电图和动脉血压。如果试验结果为阴性，则在水平位5分钟内以5微克/分钟的速率静脉注射异丙肾上腺素，随后在头部抬高60度位持续10分钟。
75例患者中有49例在倾斜试验期间诱发了血管迷走性晕厥或前驱晕厥，敏感性为65%。但45%的试验仅在使用异丙肾上腺素后呈阳性，即敏感性提高到81.5%。在96%试验结果为阳性的患者中，诱发的晕厥与自发发生的晕厥症状相符。
倾斜试验是调查晕厥病例的一种有价值的方法。超过半数病因不明的晕厥病例可以通过这种方式得到正确诊断和分类。额外使用异丙肾上腺素输注可大大提高该方法的敏感性。
