患者,女性,47岁,以"反复晕厥4年,再发1d"为主诉于2020年6月8日人院.现病史:4年前站立位时出现短暂意识丧失,面色苍白,伴出汗,晕倒在地后约5 min内自行清醒.不伴抽搐、口吐白沫、恶心、呕吐.醒后无肢体活动障碍、语言及视听障碍.以后反复类似发作,家人目击多次并送住院诊疗,外院诊断为"直立性低血压",治疗无效.发作逐渐频繁,起初数月发作1次,3年来每日均有发作,平卧发作少,被迫长期卧床.2周来无诱因加重,坐起或下床即发作.就诊于咸阳市中心医院(我院),步入门诊大厅时再次出现意识丧失.急诊科查心电图:窦性心律,心率103次/min.血糖5.5 mmol/L.以"血管迷走性晕厥?"收住院.发病以来睡眠及食欲欠佳.无头痛、胸痛、心慌、呼吸困难、咳嗽等.二便正常.个人史:无特殊,无不良嗜好.婚姻史及家族史无特殊.既往健康.

Objective The clinical features and treatment outcome in patients vasovagal syncope(VVS) were summarized.Methods One hundred seventy-seven patients were diagnosed VVS by tilt testing.VVS type,age classification,signs and symptoms of syncope episodes,occurring in different seasons as well as treatment and outcome were analysed.177 patients with positive diagnosis of VVS were treated with oral metoprolol,in some cases were implanted permanent pacemaker.Results Fifty-six cases were vascular inhibitory type,6 cases were cardiac inhibitory type,115 cases were mixed type of inhibition(respectively,31.6%,3.4%,65.0%).All patients had a sudden increasing heart rate before syncope,followed by a sudden drop and subsequent syncope occurrence.Electrocardiograms showed sinus bradycardia and cardiac arrest.The positive tilt test seemed to have no relation with the season.The patients with 40 to 59-years-old had the higher occurrence of VVS.β-blocker therapy was effective to VVS.Conclusion VVS may be caused by autonomic dysfunction,β-blocker treatment is effective.

目的:探讨应用X线胃肠造影机(胃肠机)行倾斜试验的可行性。方法:对151例不明原因晕厥或接近晕厥的患者分为两组,前85例在胃肠机上行倾斜试验,后66例在专用倾斜床上行倾斜试验,观察阳性率。结果:X线胃肠机完全符合倾斜试验要求,阳性率与专用倾斜床一致。结论:应用X线胃肠机可以行倾斜试验,便于基层医院推广应用,提高血管迷走性晕厥的诊断率。

4例晕厥患者行倾斜试验,结果阳性,诊断血管迷走性晕厥混合抑制型,心脏停搏时间较长,遂行永久起搏器植入术。术后口服足量美托洛尔,晕厥不再出现。再次行倾斜试验,结果阴性。提示:β受体阻滞剂+永久起搏器植入治疗合并严重缓慢性心律失常的血管迷走性晕厥患者,有可靠的临床效果。