从临床证据看晕厥和卒中的诊疗进展.pptx

从临床证据看晕厥和卒中的诊疗进展 2 引起摔伤的常见原因 诊断和治疗的费用昂贵 占老年人跌倒原因的10%1 占严重伤害的6%2，如：骨折、机动车事故 占轻微伤害的29%2，如：撕裂伤、擦伤 Campbell A, et al. Age and Ageing. 1981;10:264-270. Kenny RA, Kapoor WN. In: Benditt D, et al. eds. The Evaluation and Treatment of Syncope. Futura;2003:23-27 Edvardsson N. et al. Use of an implantable loop recorder to increase the diagnostic yield in unexplained syncope: results from the PICTURE registry. Europace Advance Access published November 19, 2010. Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope. N Engl J Med. 2002;347(12):878-885. [Framingham Study Population] 患者平均需要看3个科室，做13种检查; 1/3的患者因晕厥事件遭受过显著创伤3 心源性晕厥6个月死亡率超10%， 是无晕厥病人死亡率的2倍4 晕厥诊疗挑战 3 Reveal LINQ Insertable Cardiac Monitoring System | Confidential, for Internal Use Only 主要检查 检出率* ECG 2-11%1 Holter Monitoring 动态心电图 2%2 External Loop Recorder 体外循环记录仪 20%3 Tilt Table直立倾斜试验 11-87%4-5 EP Study without structural heart disease电生理检查 11%6 Neurological (CT scan, carotid doppler) 神经科检查 0-4%5 Reveal ICM 植入式心电监测 43-88%3,7,8 *(Based on mean diagnosis time of 5.1 mos.) 2 1.Kapoor WN. Diagnostic evaluation of syncope. Am J Med. January 1991;90(1):91-106. 2.Krahn AD, Klein GJ, Yee R. Recurrent syncope. Experience with an implantable loop recorder. Cardiol Clin. May 1997;15(2):313-326. 3.Krahn AD, Klein GJ, Yee R, et al. Cost implications of testing strategy in patients with syncope (RAST). J Am Coll Cardiol. August 6, 2003;42(3):495-501. 4.Kapoor WN. Evaluation and outcome of patients with syncope. Medicine (Baltimore). May 1990;69(3):160-175. 5.Kapoor WN. Evaluation and management of the patient with syncope. JAMA. November 11, 1992;268(18):2553-2560. 6.Linzer M, Yang EH, Estes NA 3rd, et al. Diagnosing syncope. Part 2: Unexplained syncope. Clinical Efficacy Assessment Project of the American College of Physicians. Ann Intern Med. July 1,1997;127(1):76-86. 7.Krahn AD, Klein GJ, Yee R, Norris C. Final results from a pilot study with an implantable loop recorder to determ