老年人神经介导性晕厥的诊断及治疗进展
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摘要
神经介导性晕厥(neurocardiogenic syncope,NCS)在院外老年晕厥患者中占比高达30%~50%,是65岁以上老年人死亡的重要原因之一。老年人发生NCS的常见病因为直立性低血压、血管迷走性晕厥和颈动脉窦敏感综合征。老年人通常缺乏晕厥先兆。65岁以上老年人由于服用多种药物,易发生药物诱发的直立性低血压晕厥。直立倾斜试验对老年人晕厥的诊断有重要价值。NCS在老年人群中的发生机制尚未阐明,也缺乏有效的治疗药物。缓解症状、改善生活质量和减少跌倒或晕厥的发生,是老年人晕厥的治疗目标。
Neurocardiogenic syncope( NCS) accounts for 30%-50% among the elderly outpatients with syncope. It is one of the important causes of death for the aging people over 65. The causes of NCS in old people are usually orthostatic hypotension,vasovagal syncope and carotid sinus syndrome. The elderly people are generally in lack of presyncope. The intake of multiple drugs easily leads to drug-induced orthostatic hypotension syncope. Tilt table test is clinically important for diagnosing syncope in elderly people. The mechanism of NCS is not clear yet in elder population and drug therapy is also not effective enough. For elderly people,the treatment of syncope aims to alleviate symptoms,improve life quality,and reduce the incidence rate of tumble or syncope.
Neurocardiogenic syncope( NCS) accounts for 30%-50% among the elderly outpatients with syncope. It is one of the important causes of death for the aging people over 65. The causes of NCS in old people are usually orthostatic hypotension,vasovagal syncope and carotid sinus syndrome. The elderly people are generally in lack of presyncope. The intake of multiple drugs easily leads to drug-induced orthostatic hypotension syncope. Tilt table test is clinically important for diagnosing syncope in elderly people. The mechanism of NCS is not clear yet in elder population and drug therapy is also not effective enough. For elderly people,the treatment of syncope aims to alleviate symptoms,improve life quality,and reduce the incidence rate of tumble or syncope.
引文
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[9]Shibao C,Lipsitz LA,Biaggioni I.ASH position paper:evaluation and treatment of orthostatic hypotension[J].J Clin Hypertension(Greenwich),2013,15(3):147-153.
[10]Yalcin A,Atmis V,Cengiz OK,et al.Evaluation of cardiac autonomic functions in older parkinson’s disease patients:a cross-sectional study[J].Aging Dis,2016,7(1):28-35.
[11]Ruwald MH,Hansen ML,Lamberts M,et al.Comparison of incidence,predictors,and the impact of co-morbidity and polypharmacy on the risk of recurrent syncope in patients<85 years versus≥85 years of age[J].Am J Cardiol,2013,112(10):1610-1615.
[12]Kenny RA,Richardson DA.Carotid sinus syndrome and falls in older adults[J].Am J Geriatric Cardiol,2001,10(2):97-99.
[13]Kenny RA,Bhangu J,King-Kallimanis BL.Epidemiology of syncope/collapse in younger and older western patient populations[J].Prog Cardiovasc Dis,2013,55(4):357-363.
[14]Raviele A,Menozzi C,Brignole M,et al.Value of headup tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope[J].Am J Cardiol,1995,76(4):267-272.
[15]Aydin AE,Soysal P,Isik AT.Which is preferable for orthostatic hypotension diagnosis in older dults:active standing test or head-up tilt table test[J].Clin Interv Aging,2017,25(12):207-212.
[16]Trevisan C,Di Gregorio P,Debiasi E,et al.Factors influencing short-term outcomes for older patients accessing emergency departments after a fall:the role of fall dynamics[J].Gait Posture,2017,58:463-468.
[17]Alegria JR,Gersh BJ,Scott CG,et al.Comparison of frequency of recurrent syncope after beta-blocker therapy versus conservative management for patients with vasovagal syncope[J].Am J Cardiol,2003,92(1):82-84.
[18]Sheldon R,Connolly S,Rose S,et al.Prevention of Syncope Trial(POST):a randomized,placebo-controlled study of metoprolol in the prevention of vasovagal syncope[J].Circulation,2006,113(9):1164-1170.
[19]Raj SR,Coffin ST.Medical therapy and physical maneuvers in the treatment of the vasovagal syncope and orthostatic hypotension[J].Prog Cardiovasc Dis,2013,55(4):425-433.
[2]Tan MP,Parry SW.Vasovagal syncope in the older patient[J].J Am Coll Cardiol,2008,51(6):599-606.
[3]Kenny RA,Bhangu J,King-Kallimanis BL.Epidemiology of syncope/collapse in younger and older western patient populations[J].Prog Cardiovasc Dis,2013,55(4):357-363.
[4]Ganzeboom KS,Mairuhu G,Reitsma JB,et al.Lifetime cumulative incidence of syncope in the general population:a study of 549 Dutch subjects aged 35-60 years[J].J Cardiovasc Electrophysiol,2006,17(11):1172-1176.
[5]Romme JJ,van Dijk N,Boer KR,et al.Influence of age and gender on the occurrence and presentation of reflex syncope[J].Clin Auton Res,2008,18(3):127-133.
[6]Solbiati M,Sheldon R,Seifer C,et al.Managing syncope in the elderly:the not so simple faint in aging patients[J].Can J Cardiol,2016,32(9):1124-1131.
[7]Aydin AE,Soysal P,Isik AT.Which is preferable for orthostatic hypotension diagnosis in older adults active standing test or head-up tilt table test?[J].Clin Interv Aging,2017,25(12):207-212.
[8]Wong CW.Complexity of syncope in elderly people:a comprehensive geriatric approach[J].Hong Kong Med J,2018,24(2):182-190.
[9]Shibao C,Lipsitz LA,Biaggioni I.ASH position paper:evaluation and treatment of orthostatic hypotension[J].J Clin Hypertension(Greenwich),2013,15(3):147-153.
[10]Yalcin A,Atmis V,Cengiz OK,et al.Evaluation of cardiac autonomic functions in older parkinson’s disease patients:a cross-sectional study[J].Aging Dis,2016,7(1):28-35.
[11]Ruwald MH,Hansen ML,Lamberts M,et al.Comparison of incidence,predictors,and the impact of co-morbidity and polypharmacy on the risk of recurrent syncope in patients<85 years versus≥85 years of age[J].Am J Cardiol,2013,112(10):1610-1615.
[12]Kenny RA,Richardson DA.Carotid sinus syndrome and falls in older adults[J].Am J Geriatric Cardiol,2001,10(2):97-99.
[13]Kenny RA,Bhangu J,King-Kallimanis BL.Epidemiology of syncope/collapse in younger and older western patient populations[J].Prog Cardiovasc Dis,2013,55(4):357-363.
[14]Raviele A,Menozzi C,Brignole M,et al.Value of headup tilt testing potentiated with sublingual nitroglycerin to assess the origin of unexplained syncope[J].Am J Cardiol,1995,76(4):267-272.
[15]Aydin AE,Soysal P,Isik AT.Which is preferable for orthostatic hypotension diagnosis in older dults:active standing test or head-up tilt table test[J].Clin Interv Aging,2017,25(12):207-212.
[16]Trevisan C,Di Gregorio P,Debiasi E,et al.Factors influencing short-term outcomes for older patients accessing emergency departments after a fall:the role of fall dynamics[J].Gait Posture,2017,58:463-468.
[17]Alegria JR,Gersh BJ,Scott CG,et al.Comparison of frequency of recurrent syncope after beta-blocker therapy versus conservative management for patients with vasovagal syncope[J].Am J Cardiol,2003,92(1):82-84.
[18]Sheldon R,Connolly S,Rose S,et al.Prevention of Syncope Trial(POST):a randomized,placebo-controlled study of metoprolol in the prevention of vasovagal syncope[J].Circulation,2006,113(9):1164-1170.
[19]Raj SR,Coffin ST.Medical therapy and physical maneuvers in the treatment of the vasovagal syncope and orthostatic hypotension[J].Prog Cardiovasc Dis,2013,55(4):425-433.