Biffi M, Boriani G, Sabbatani P, Bronzetti G, Frabetti L, Zannoli R, Branzi A, Magnani B
Institute of Cardiology, Policlinico S Orsola, University of Bologna, Italy.
Heart. 1997 Mar;77(3):268-72. doi: 10.1136/hrt.77.3.268.
To evaluate the efficacy of head up tilt guided treatment with metoprolol and clonidine in preventing the recurrence of syncope in patients with malignant vasovagal syncope.
20 patients (9 men and 11 women, mean age 33 (SD 17), range 14 to 62 years) with severe symptoms.
Randomised double blind crossover trial; efficacy was assessed by head up tilt testing.
Metoprolol was more effective than clonidine in abolishing syncope (19/20 v 1/20, P < 0.001) but clonidine showed some beneficial effects on time to syncope and severity of hypotension in 12 patients. During an average follow up of 15 (3) months there was a significant reduction in the recurrence of symptoms compared with the previous year in patients who had tilt up guided treatment (18 metoprolol, 1 clonidine).
Treatment guided by head up tilting is a reliable method of treating patients with malignant vasovagal syndrome. Metoprolol was an effective long term treatment for preventing syncope. High doses were more effective and a careful dose titration period helped to minimise withdrawal symptoms and side effects.
评估美托洛尔和可乐定在头高位倾斜引导下治疗对预防恶性血管迷走性晕厥患者晕厥复发的疗效。
20例有严重症状的患者(9例男性,11例女性,平均年龄33岁(标准差17),年龄范围14至62岁)。
随机双盲交叉试验;通过头高位倾斜试验评估疗效。
美托洛尔在消除晕厥方面比可乐定更有效(19/20对1/20,P<0.001),但可乐定对12例患者的晕厥时间和低血压严重程度有一些有益影响。在平均15(3)个月的随访期间,与前一年相比,接受头高位倾斜引导治疗的患者(18例美托洛尔,1例可乐定)症状复发显著减少。
头高位倾斜引导治疗是治疗恶性血管迷走综合征患者的可靠方法。美托洛尔是预防晕厥的有效长期治疗药物。高剂量更有效,仔细的剂量滴定期有助于将撤药症状和副作用降至最低。