晕厥的病因和诊断策略陈庆华课件.ppt

晕厥的病因和诊断策略;The Significance of Syncope;1 Day SC, et al. Am J of Med 1982;73:15-23. 2 Kapoor W. Medicine 1990;69:160-175. 3 Silverstein M, Sager D, Mulley A. JAMA. 1982;248:1185-1189. 4 Martin G, Adams S, Martin H. Ann Emerg Med. 1984;13:499-504.;短暂的意识丧失 (TLOC);晕厥 特点;;其他病因和类似病症;Cardiac Rhythms During Unexplained Syncope;;诊断目的;;体格检查;颈动脉窦按摩 (CSM);其他检查;Heart Monitoring Options; ATP试验：可短暂使血管迷走神经张力增高 电生理检查 (EPS) 倾斜试验 脑电图, 头颅 CT, 头颅 MRI 可能有助诊断癫痫 颈椎MRI ;电生理检查价值;电生理检查局限性 ; 正常人当体位由平卧 头高倾斜立位 , 静脉回流减少 ,心室充盈下降 ,减少了（与脑干迷走背核直接相连系的）心室后下壁Ｃ纤维 的激活 ,反射性地增加了交感输出 ,结果心跳加快 ,周围血管阻力增高。所以 ,体位直立的正常反应是心率增快 ,舒张压升高 ,收缩压轻度升高。 ;;血压下降标准为收缩压≤ 80ｍｍＨｇ和 (或 )舒张压≤ 50 ｍｍＨｇ ,或平均动脉压下降≥25%。 有的患者即使血压未达到此标准 ,但已出现晕厥或接近晕厥症状 ,仍应判为阳性。;倾斜试验阳性标准（心率）;;??? 反复发作频繁的ＶＶＳ患者应给予治疗。 β受体阻滞剂 ,可阻滞儿茶酚胺的作用 ,降低Ｃ纤维的刺激 丙吡胺也可应用 ,它通过抗胆碱能和负性肌力作用而达治疗目的。 茶碱类对抗腺苷介导的低血压和心动过缓 ,因此也有治疗作用。 氟氢考的松为盐皮质酮 ,具有保钠、扩容作用 ,可能减少ＶＶＳ发作。 以心脏抑制型为主 ,而药物效果不好者 ,可考虑置入双腔起搏器。 ;;;;;Head-Up Tilt Test:ECG Leads and Intra-Arterial Pressure Tracing;Adenosine Triphosphate (ATP) Test;;Insertable Loop Recorder (ILR);;;Randomized Assessment of Syncope Trial (RAST);ISSUEInternational Study of Syncope of Uncertain Etiology;ISSUEPatients with Isolated Syncope and Tilt-Positive Syncope;ISSUE Patients with Heart Disease and a Negative EP Test;ISSUEPatients with Heart Disease and a Negative EP Test;ISSUEPatients with Bundle Branch Block and Negative EP Test;ISSUEPatients with Bundle Branch Block and Negative EP Test;Section III:Specific Conditions and Treatment;;Cardiac Syncope;;Syncope Due to Structural Cardiovascular Disease: Principle Mechanisms;Syncope Due to Cardiac Arrhythmias;ILR Recordings;Long QT Syndromes;;;Drug-Induced QT Prolongation(List is continuously being updated);Treatment of Long QT;Treatment of Syncope Due to Bradyarrhythmia;Treatment of Syncope Due to Tachyarrhythmia;Neurally-Mediated Reflex Syncope;;VVSClinical Pathophysiology;VVSIncidence;VVS vs. CSS;VVS Recurrences;;;VVS General Treatment Measures ;;VVS Tilt Training: Clin