医学晕厥诊断与处理.pptVIP

有意义的指标 ? 诱发出单形室速 ? 诱发出 SVT 伴低血压 ? SNRT 3000 ms or CSRT 600 ms ? HV interval ≥ 100 ms ? 心房起搏诱发结下阻滞 脑 电 图 ? 非一线选用 ? 鉴别晕厥和癫痫 ? 癫痫 — 发作间期也有异常 ? 晕厥 — 正常 颈动脉窦按摩 (CSM) ? 先右后左 ? 按摩而不是阻断 ? 按摩时间 5-10 秒 ? 立位或卧位 ? 记录心电及血压 3 秒长间隙 50mmHg 收 缩压下降 症状 Carotid Sinus + 晕厥的诊断与处理 Syncope 晕厥的诊断与处理 ? 晕厥的概念 ? 晕厥的诊断 ? 晕厥的治疗 一 . 晕厥的一般概念 什么是晕厥 ? 突发、短暂的意识丧失伴晕倒 — 突然脑灌注不足 与猝死的不同能 — “ 醒过来” Definition of Syncope ? Syncope is a symptom , the defining clinical characteristics of which are: ? 1. Transient ? 2. Self-limited loss of consciousness leading to falling ? 3. Onset is relatively rapid ? 4. Recovery is spontaneous, complete , and usually prompt. 症状四大特点 临床症状 : ? 自发的意识丧失 ? 快速性 ? 有先兆 ? 自限性、完全恢复（与猝死的差别） 晕厥的原因 ( 晕厥门诊 ) Orthostatic Cardiac Arrhythmia Structural Cardio- Pulmonary * 1 ? Vasovagal ? Carotid Sinus ? Situational ? Cough ? Post- micturition 2 ? Drug Induced ? ANS Failure ? Primary ? Secondary 3 ? Brady ? Sick sinus ? AV block ? Tachy ? VT ? SVT ? Long QT Syndrome 4 ? Aortic Stenosis ? HOCM ? Pulmonary Hypertension 5 Cerebro- vascular Neurally- Mediated Unknown Cause = 18% 56% 2% 20% 3% 1% Alboni P , et al. JACC 2001; 37: 1921-1928 ? Steal Syndrome ? TIA ? Epilepsy Classification of transient loss of consciousness ? Syncope 1.Neurally-mediated reflex syncopal syndromes 2.Cardiac arrhythmia as primary causes 3.Structural cardiac or cardiopulmonary diseases 4.Cerebrovascular ? Non-syncopal attacks 1. With impairment or loss of consciousness 2. Without loss of consciousness Causes of Syncope 1. Neurally-mediated reflex syncopal syndromes a. Vasovagal faint b. Carotid sinus syncope c. Situational faint: Acute haemorryaging Coughing, sneezing Gastrointestinal stimulation(swallowing, defacation, visceral pain) Micturation(Post-micturation) Post-exercise Other(e.g. Brass instrument playing, weighlifting, post- prandial) D. Glossopharyngeal and trigeminal neuralgia Causes of Syncope( cont.) 2. Orthostatic hypotension Autonomic failure Primary autonomic failur