基础试验不同时长对直立倾斜试验结果的影响

Effect of prolonged head-up tilt test on neurally mediated syncope

关键词:  神经介导性晕厥  直立倾斜试验  基础试验时程

Key words:  neurally mediated syncope  head-up tilt test  passive basic phase

摘要:

目的　探讨延长基础试验时间对神经介导性晕厥（neurally mediated syncope,NMS)患者直立倾斜试验（head-up tilt test, HUTT)阳性率的影响。方法　连续选取2019年4—10月在大连医科大学附属第一医院门诊及住院考虑神经介导性晕厥患者82例，交替顺序分为30 min基础试验组和45 min基础试验组。比较两组患者的试验结果阳性率、阳性反应分型、晕厥或晕厥前兆发作时间等。结果　30 min基础试验组阳性反应23例（56.1%），45 min基础试验组阳性反应24例（58.5%），两组阳性率无明显差异。基础试验阶段呈阳性反应9例，均为45 min基础试验组患者。其余73例（89%）需药物激发进行阳性结果诊断。总阳性反应类型在两组间无明显差异，以血管抑制型多见。药物激发后发生阳性反应时间在两组间差异有统计学意义［（4.96±3.2）min vs (7.93±3.1）min，P＜0.01］，30 min基础试验组多发生在含药5 min之内，45 min基础试验组阳性反应时间多发生在5 min之后。45 min基础试验组较30 min基础试验组阳性病例检查总时间明显延长［（52.93±3.1）min vs (34.67±1.3)min，P<0.05］。结论　45 min基础时程HUTT较30 min基础时程HUTT可增加10%的无药物激发阳性反应者，但诊断NMS整体阳性率并未提高。45 min基础试验组患者行药物激发阳性反应时间推迟，总检查时间明显延长。大多数NMS患者可以通过30 min基础时程HUTT获得确定诊断。

Abstract:

Objective　 To evaluate the effect of prolonged head-up tilt test (HUTT) on neurally mediated syncope (NMS) and analyze the results of HUTT. Methods　 A total of 82 patients, who underwent HUTT in the First Affiliated Hospital of Dalian Medical University from April to October 2019 due to recurrent syncope, were included in this study. Patients were alternatively divided into test group (45 minutes passive basic phase) and control group (30 minutes passive basic phase) (each n=41). Positive results, type and time of positive reactions were compared between two groups. Results 　The positive rate of HUTT was similar between two groups with 23 positive reaction cases in control group and 24 in test group. The rate of vasodepressor type of VVS was higher than the other two types. During nitroglycerin provocation phase, most positive reactions occurred within 10 minutes in the two groups. The time to positive response after nitroglycerin provocation was significant different between two groups, with control group occurring in 5 minutes and test group occurring after 5 minutes (P＜0.01). Conclusions 　A 30 minutes passive basic phase may be an appropriate duration for the most NMS individuals, prolonged HUTT may have no more contribution.