晕厥的病因和诊断策略.ppt

Most recently the Syncope Evaluation in the Emergency Department Study (SEEDS) was performed at the Mayo Clinic.* It became clear that a careful evaluation performed in a syncope unit in the Emergency Department was much more beneficial than admission to the hospital. Prospective randomized clinical trial: syncope unit evaluation vs. standard care. N=103 consecutive patients 51 randomized to the syncope unit 52 received standard care Presumptive diagnosis was established in 34 (67%) and 5 (10%) patients (P0.001), for the syncope unit and standard care groups, respectively Hospital admission was required for 22 (43%) and 51 (98%) patients (P0.001) Actuarial survival was 97% and 90% (P=0.30) Survival free from recurrent syncope was 88% and 89% (P=0.72) at 2 years Total patient-hospital days were reduced from 140 to 64 Conclusion: A syncope unit designed for this study significantly improved diagnostic yield in the emergency department and reduced hospital admission and total length of hospital stay without affecting recurrent syncope and all-cause mortality among intermediate-risk patients. *Shen W, Decker W, Smars P, et al. Syncope evaluation in the emergency department study (SEEDS).  Circulation. 2004;110:3636-3645. Example of marked bradycardia recorded during a spontaneous vasovagal syncope. The asystolic periods may be impressive in their duration but do not in themselves constitute an indication for cardiac pacing. From the files of DG Benditt, MD. University of Minnesota Cardiac Arrhythmia Center Vasovagal syncope is most effectively diagnosed if the detailed medical history is ‘classic’. However, this is not often the case, and supporting evidence is needed. Such supportive evidence may include: Patient history, physical examination, including ECG and blood pressure Patient experiences syncope during tilt table testing. Test completion without syncope is a negative result. The following is one tilt table protocol: At least a 2 hour fast Measure