住院晕厥患者病因及诊治状况分析

发布时间：2019-06-29 07:20

【摘要】：背景目前,晕厥的病因诊断仍有一定困难,并存在诊治不规范现象。目的探讨晕厥的病因分布和诊治的不足之处,提高临床医生对晕厥的正确认识。方法选取2006年12月—2016年6月在北京大学人民医院入院和/或出院诊断为"晕厥"和/或"意识丧失"的住院患者为研究对象。收集患者一般资料,以及发作诱因、意识丧失发作前中后症状、"意识丧失"和"晕厥"出现的频次、与"意识丧失"和/或"晕厥"相关的出入院诊断等。结果共纳入509例"晕厥"和/或"意识丧失"患者进行分析,其中病因明确239例,包括晕厥182例(76.2%),非晕厥57例(23.8%)。病因明确的晕厥患者病因依次为神经介导性晕厥(100例,54.9%)、心源性晕厥(59例,32.4%)、直立性低血压性晕厥(17例,9.3%)、其他复合病因晕厥(6例,3.4%)。入院诊断为"晕厥",但病因中包含非晕厥疾病(如癫痫、短暂性脑缺血发作)的患者共116例。出院诊断为"晕厥",但病因中包含非晕厥疾病的患者共21例。84例患者的病程记录中,76例(90.5%)存在"意识丧失"和"晕厥"概念混淆的情况。509例患者共1 084人次发作意识丧失,未记录发作诱因有147人次(13.6%),而未记录前驱症状、发作中或发作后症状分别有354人次(32.7%)、299人次(27.6%)和353人次(32.6%);诊断明确的182例晕厥患者共395人次发作晕厥,未记录发作诱因有47人次(11.9%),未记录前驱症状、发作中或发作后症状分别有131人次(33.2%)、127人次(32.2%)和136人次(34.4%)。临床医生对神经介导性晕厥患者的治疗以教育(43例,43.0%)和功能锻炼(13例,13.0%)为主,心源性晕厥患者多给予植入起搏器(24例,40.7%)或植入型心律转复除颤器(14例,23.7%),直立性低血压性晕厥患者给予调整药物和教育治疗分别为9、3例。上述3种病因所致的晕厥患者中,未给予任何治疗者共39例(22.2%)。结论住院晕厥患者病因主要为神经介导性晕厥,其次为心源性晕厥、直立性低血压性晕厥和其他复合病因晕厥;临床诊疗过程中存在意识丧失和晕厥概念混淆、病史询问不详细、治疗不充分的现象。
[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.
【作者单位】：北京大学人民医院心血管内科急性心肌梗死早期预警和干预北京市重点实验室;
【分类号】：R441

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