0.25 mg低剂量硝酸甘油激发直立倾斜试验在血管迷走性晕厥诊断中的应用

doi:10.3969/j.issn.1673-5765.2020.06.012

摘要/Abstract

摘要：

目的评价0.25 mg低剂量硝酸甘油激发直立倾斜试验（head-up tilt testing，HUTT）诊断血管迷走性晕厥（vasovagal syncope，VVS）的临床可行性。方法入选疑似VVS患者进行0.25 mg低剂量硝酸甘油激发HUTT检查，通过无创连续逐搏血压监测数据的脱机分析，获取阳性率和达到阳性反应时间，并与既往国内外研究相比较。结果共入组疑似VVS患者343例，241例（70.3%）在HUTT过程中出现了阳性结果，其中混合型83例（34.4%），心脏抑制型2例（0.8%），血管减压型156例（64.7%）。低剂量硝酸甘油药物激发阶段阳性率与国外既往研究差异无统计学意义，整体阳性率与国外既往研究差异无统计学意义，但高于国内既往研究（70.3% vs 64%，P =0.016）。低剂量硝酸甘油激发阶段出现阳性反应的时间低于国外既往使用0.3 mg片剂舌下含服激发的研究（5.0±2.2 min vs 7±8 mi n，P =0.001），与使用0.4 mg硝酸甘油舌下喷雾研究结果的差异无统计学意义（P＞0.99）。结论 0.25 mg低剂量硝酸甘油激发HUTT的阳性率和达到阳性反应时间与国外0.4 mg硝酸甘油激发 HUTT的结果无差异，具有临床应用的可行性。

文章导读： 本研究证明，在HUTT诊断血管迷走性晕厥中应用更方便获取和更低剂量的硝酸甘油（0.25 mg）同样可以获得理想的阳性率，且达到阳性反应时间也与更高剂量的硝酸甘油方案相似。

关键词: 直立倾斜试验; 硝酸甘油; 血管迷走性晕厥

Abstract:

Objective To evaluate the feasibility of 0.25 mg low-dose nitroglycerin-stimulated head-up tilt testing (HUTT) for the diagnosis of vasovagal syncope (VVS) . Methods Patients with suspected VVS were selected in this study for a HUTT provoked by 0.25 mg low-dose sublingual nitroglycerin. Noninvasive beat to beat blood pressure was monitored continuously, then the positive rate and the time from tilt to presyncope were compared with that in previous studies. Results A total of 343 patients were included, of whom 241 patients (70.3%) were elicited a positive result by the low-dose nitroglycerin-stimulated HUTT. Of the positive HUTT patients, 83 (34.4%) were mixed syncope, 2 (0.8%) were cardioinhibitory syncope and 156 (64.7%) were vasodepressor syncope. No significant differences in the drug provoked positive rate and overall positive rate were found between this study and previous international studies, while the overall positive rate in this study was higher than that in previous domestic studies (70.3% vs 64%, P =0.016). The time from tilt to presyncope in this study was shorter, compared to that in the study using 0.3 mg sublingual nitroglycerin (5.0±2.2 min vs 7±8 min, P =0.001), while had no statistical difference with that in the study using 0.4 mg sublingual nitroglycerin (spray) (P >0.99).

Conclusions Due to an acceptable positive result, the drug stimulated HUTT by 0.25 mg low-dose nitroglycerin are feasible in the clinical practice.

Key words: Head-up tilt testing; Nitroglycerin; Vasovagal syncope

刘杰昕*，杜嵩*，王跃，金泽宁，黄泽民，宋柯，樊志奇，陈章煌，吴斌（*第一作者）. 0.25 mg低剂量硝酸甘油激发直立倾斜试验在血管迷走性晕厥诊断中的应用[J]. 中国卒中杂志, 2020, 15(06): 637-643.

LIU Jie-Xin, DU Song, WANG Yue, JIN Ze-Ning, HUANG Ze-Ming, SONG Ke, FAN Zhi-Qi, CHEN Zhang-Huang, WU Bin. Application Value of 0.25 mg Low-dose Nitroglycerin-stimulated Head-up Tilt Test for the Diagnosis of Vasovagal Syncope[J]. Chinese Journal of Stroke, 2020, 15(06): 637-643.

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