Kardos A, Avramov K, Dongó A, Gingl Z, Kardos L, Rudas L
II. sz. Belgyógyászati Klinika, Szent-Gyorgyi Albert Orvostudományi Egyetern, Szeged.
Orv Hetil. 1996 Oct 27;137(43):2407-11.
A case of a 66-year-old man with recurrent episodes of syncope is reported. The syncopal attacks started five years ago in sitting and standing positions. At the time of admission the fainting attacks occurred 2-3 times per day. The diagnostic tests revealed severe orthostatic hypotension. The medical treatment was started with salt enriched diet and fludrocortisone. The efficacy of the therapy was tested by using the tilt table test with a self developed computer system consisting of a non-invasive finger blood pressure monitor and ECG. The orthostatic tolerance improved with the medical therapy, however remained unsatisfactory for the patient's daily activity. Though the patient had less frequent symptoms, he had still sustained episodes of recurrent syncopes. The medical therapy was than combined with sleeping in the 15 degrees head-up-tilt position. The repeat tilt table test was performed two weeks after initiation of the 15 degrees head-up-tilt sleeping. The orthostatic tolerance was markedly improved. The patient became free of symptoms and during a four-week follow-up his condition remained stable. At the control the patient reported about deterioration of his symptoms as a result of the discontinuation of sleeping in "head-up-tilt" position for two weeks. The objective signs leading to aggravate his symptoms was documented by the tilt table test. We reinstituted the "head-up-tilt" sleeping in his therapeutic management.
报告了一例66岁男性反复出现晕厥发作的病例。晕厥发作始于五年前，发作时患者处于坐位和立位。入院时，晕厥发作每天发生2 - 3次。诊断检查显示严重的体位性低血压。治疗从高盐饮食和氟氢可的松开始。通过使用由无创手指血压监测仪和心电图组成的自行开发的计算机系统进行倾斜试验来测试治疗效果。体位耐受性通过药物治疗有所改善，但对于患者的日常活动仍不尽人意。尽管患者症状发作频率降低，但仍有反复晕厥发作。随后药物治疗联合15度头高位睡眠。在开始15度头高位睡眠两周后进行重复倾斜试验。体位耐受性明显改善。患者症状消失，在四周的随访期间病情保持稳定。复查时，患者报告因停止“头高位”睡眠两周，症状恶化。倾斜试验记录了导致其症状加重的客观体征。我们在其治疗方案中重新采用了“头高位”睡眠。
