住院暈厥患者病因及診治狀況分析
發(fā)布時間：2019-06-29 07:20
【摘要】：背景目前,暈厥的病因診斷仍有一定困難,并存在診治不規(guī)范現(xiàn)象。目的探討暈厥的病因分布和診治的不足之處,提高臨床醫(yī)生對暈厥的正確認識。方法選取2006年12月—2016年6月在北京大學(xué)人民醫(yī)院入院和/或出院診斷為"暈厥"和/或"意識喪失"的住院患者為研究對象。收集患者一般資料,以及發(fā)作誘因、意識喪失發(fā)作前中后癥狀、"意識喪失"和"暈厥"出現(xiàn)的頻次、與"意識喪失"和/或"暈厥"相關(guān)的出入院診斷等。結(jié)果共納入509例"暈厥"和/或"意識喪失"患者進行分析,其中病因明確239例,包括暈厥182例(76.2%),非暈厥57例(23.8%)。病因明確的暈厥患者病因依次為神經(jīng)介導(dǎo)性暈厥(100例,54.9%)、心源性暈厥(59例,32.4%)、直立性低血壓性暈厥(17例,9.3%)、其他復(fù)合病因暈厥(6例,3.4%)。入院診斷為"暈厥",但病因中包含非暈厥疾病(如癲癇、短暫性腦缺血發(fā)作)的患者共116例。出院診斷為"暈厥",但病因中包含非暈厥疾病的患者共21例。84例患者的病程記錄中,76例(90.5%)存在"意識喪失"和"暈厥"概念混淆的情況。509例患者共1 084人次發(fā)作意識喪失,未記錄發(fā)作誘因有147人次(13.6%),而未記錄前驅(qū)癥狀、發(fā)作中或發(fā)作后癥狀分別有354人次(32.7%)、299人次(27.6%)和353人次(32.6%);診斷明確的182例暈厥患者共395人次發(fā)作暈厥,未記錄發(fā)作誘因有47人次(11.9%),未記錄前驅(qū)癥狀、發(fā)作中或發(fā)作后癥狀分別有131人次(33.2%)、127人次(32.2%)和136人次(34.4%)。臨床醫(yī)生對神經(jīng)介導(dǎo)性暈厥患者的治療以教育(43例,43.0%)和功能鍛煉(13例,13.0%)為主,心源性暈厥患者多給予植入起搏器(24例,40.7%)或植入型心律轉(zhuǎn)復(fù)除顫器(14例,23.7%),直立性低血壓性暈厥患者給予調(diào)整藥物和教育治療分別為9、3例。上述3種病因所致的暈厥患者中,未給予任何治療者共39例(22.2%)。結(jié)論住院暈厥患者病因主要為神經(jīng)介導(dǎo)性暈厥,其次為心源性暈厥、直立性低血壓性暈厥和其他復(fù)合病因暈厥;臨床診療過程中存在意識喪失和暈厥概念混淆、病史詢問不詳細、治療不充分的現(xiàn)象。
[Abstract]:Background at present, the etiological diagnosis of syncope is still difficult and there is a phenomenon of irregular diagnosis and treatment. Objective to explore the etiological distribution, diagnosis and treatment of syncope, and to improve the correct understanding of syncope among clinicians. Methods from December 2006 to June 2016, inpatients admitted and / or diagnosed as "syncope" and / or "loss of consciousness" in Peking University people's Hospital were selected as subjects. The general data of the patients, as well as the inducement of the attack, the symptoms before and after the onset of loss of consciousness, the frequency of "loss of consciousness" and "syncope", and the diagnosis of admission related to "loss of consciousness" and / or "syncope" were collected. Results A total of 509 patients with "syncope" and / or "loss of consciousness" were analyzed, including 182 cases (76.2%) and 57 cases (23.8%) of non-syncope, including 182 cases (76.2%) of syncope and 57 cases (23.8%) of non-syncope. The causes of syncope were neuromediated syncope (100 cases, 54.9%), cardiogenic syncope (59 cases, 32.4%), orthostatic hypotension syncope (17 cases, 9.3%) and other compound syncope (6 cases, 3.4%). A total of 116 patients were diagnosed as syncope, but the etiology included non-syncope diseases (such as epilepsy, transient ischemic attack). A total of 21 patients with non-syncope were diagnosed as syncope at discharge. 76 (90.5%) of 84 patients had confusion of the concepts of "loss of consciousness" and "syncope". A total of 1084 patients lost consciousness and 147 patients (13.6%) had no record of prodromal symptoms. The number of symptoms during or after attack was 354 (32.7%), 299 (27.6%) and 353 (32.6%), respectively. A total of 395 syncope were diagnosed in 182 patients, 47 (11.9%) were not recorded, 131 (33.2%), 127 (32.2%) and 136 (34.4%) were not recorded. The main treatment of neurogenic syncope was education (43 cases, 43.0%) and functional exercise (13 cases, 13.0%). Pacemakers (24 cases, 40.7%) or implantable cardioverter defibrillators (23.7%) were mostly given to patients with cardiogenic syncope. 9 cases were treated with adjusted drugs and 3 cases with orthostatic hypotension syncope. Among the patients with syncope caused by the above three causes, 39 patients (22.2%) were not given any treatment. Conclusion the main causes of inpatients with syncope are neuromediated syncope, followed by cardiogenic syncope, orthostatic hypotension syncope and other compound syncope, and there is confusion between consciousness loss and syncope in the process of clinical diagnosis and treatment, and the medical history is not detailed and the treatment is insufficient.
【作者單位】： 北京大學(xué)人民醫(yī)院心血管內(nèi)科急性心肌梗死早期預(yù)警和干預(yù)北京市重點實驗室;
【分類號】：R441
本文編號：2507655
[Abstract]:Background at present, the etiological diagnosis of syncope is still difficult and there is a phenomenon of irregular diagnosis and treatment. Objective to explore the etiological distribution, diagnosis and treatment of syncope, and to improve the correct understanding of syncope among clinicians. Methods from December 2006 to June 2016, inpatients admitted and / or diagnosed as "syncope" and / or "loss of consciousness" in Peking University people's Hospital were selected as subjects. The general data of the patients, as well as the inducement of the attack, the symptoms before and after the onset of loss of consciousness, the frequency of "loss of consciousness" and "syncope", and the diagnosis of admission related to "loss of consciousness" and / or "syncope" were collected. Results A total of 509 patients with "syncope" and / or "loss of consciousness" were analyzed, including 182 cases (76.2%) and 57 cases (23.8%) of non-syncope, including 182 cases (76.2%) of syncope and 57 cases (23.8%) of non-syncope. The causes of syncope were neuromediated syncope (100 cases, 54.9%), cardiogenic syncope (59 cases, 32.4%), orthostatic hypotension syncope (17 cases, 9.3%) and other compound syncope (6 cases, 3.4%). A total of 116 patients were diagnosed as syncope, but the etiology included non-syncope diseases (such as epilepsy, transient ischemic attack). A total of 21 patients with non-syncope were diagnosed as syncope at discharge. 76 (90.5%) of 84 patients had confusion of the concepts of "loss of consciousness" and "syncope". A total of 1084 patients lost consciousness and 147 patients (13.6%) had no record of prodromal symptoms. The number of symptoms during or after attack was 354 (32.7%), 299 (27.6%) and 353 (32.6%), respectively. A total of 395 syncope were diagnosed in 182 patients, 47 (11.9%) were not recorded, 131 (33.2%), 127 (32.2%) and 136 (34.4%) were not recorded. The main treatment of neurogenic syncope was education (43 cases, 43.0%) and functional exercise (13 cases, 13.0%). Pacemakers (24 cases, 40.7%) or implantable cardioverter defibrillators (23.7%) were mostly given to patients with cardiogenic syncope. 9 cases were treated with adjusted drugs and 3 cases with orthostatic hypotension syncope. Among the patients with syncope caused by the above three causes, 39 patients (22.2%) were not given any treatment. Conclusion the main causes of inpatients with syncope are neuromediated syncope, followed by cardiogenic syncope, orthostatic hypotension syncope and other compound syncope, and there is confusion between consciousness loss and syncope in the process of clinical diagnosis and treatment, and the medical history is not detailed and the treatment is insufficient.
【作者單位】： 北京大學(xué)人民醫(yī)院心血管內(nèi)科急性心肌梗死早期預(yù)警和干預(yù)北京市重點實驗室;
【分類號】：R441
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