老年性晕厥的临床特征及其预后的影响因素
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摘要
目的观察急诊老年性晕厥患者临床特征和远期生存情况,分析影响老年晕厥患者预后的危险因素。方法选取2017年1月至2018年1月佛冈县人民医院急诊科收治的老年性晕厥患者120例,分析老年性晕厥发病诱因、晕厥类型、症状体征、疾病转归等临床特征,所有患者随访1年,统计随访期间患者晕厥复发和死亡情况,Logistic回归分析影响老年性晕厥患者预后的危险因素。结果本组患者反射性晕厥36例(30.00%),心源性晕厥43例(35.83%),脑源性晕厥31例(25.83%),低血糖2例(1.67%),贫血3例(2.50%),5例(4.17%)无发现异常;96例(80.00%)发病无前驱症状,82例(68.33%)经急救后症状好转,38例(31.67%)无好转;108例(90.00%)随访1年,随访期间晕厥复发率为32.41%(35/108),死亡率为33.33%(36/108);单因素分析结果显示,老年性晕厥预后与年龄、性别、合并高血压、冠心病、晕厥类型、无前驱症状、心电图异常有关(P<0.05);Logistic回归分析结果显示,年龄≥70岁(β=-0.526,P=0.001)、合并冠心病(β=0.687,P<0.05)、心源性晕厥(β=0.913,P=0.005)、无前驱症状(β=0.529,P=0.003)是影响老年性晕厥预后的独立危险因素。结论急诊老年性晕厥以心源性晕厥多见,复发和病死率高,高龄、合并冠心病、心源性晕厥、无前驱症状是影响患者预后的危险因素。
Objective To observe the clinical features and long-term survival of elderly patients with emergency syncope, and to analyze the risk factors affecting the prognosis of elderly patients with syncope. Methods A total of 120 elderly patients with syncope admitted to Department of Emergency Medicine, Fogang county People's Hospital from Jan. 2017 to Jan. 2018 were selected to analyze the clinical characteristics of senile syncope, such as its causes, syncope types, symptoms and signs, disease outcomes. All patients were followed up for one year. The recurrence and death of syncope during the follow-up period were counted. Logistic regression was used to analyze the risk factor of influencing the prognosis of senile syncope patients. Results Of the 120 cases, 36 cases(30.00%) of reflex syncope, 43 cases(35.83%) of cardiogenic syncope, 31 cases(25.83%) of encephalogenic syncope, 2 cases(1.67%) of hypoglycemia, 3 cases(2.50%) of anemia, 5 cases(4.17%) of no abnormalities were found; 96 cases(80.00%) had no prodromal symptoms, 82 cases(68.33%) had better symptoms after emergency treatment, and 38 cases(31.67%) had no improvement.108 cases(90.00%) were followed up for one year, and during the follow-up period, the recurrence rate of syncope was 32.41%(35/108) and the mortality rate was 33.33%(36/108). Univariate analysis showed that the prognosis of senile syncope was related to age, sex, hypertension, coronary heart disease, syncope type, absence of prodromal symptoms and abnormal electrocardiogram(P<0.05). Logistic regression analysis showed that age ≥70 years old(β=-0.526, P=0.001), coronary heart disease(β=0.687, P<0.05), cardiogenic syncope(β=0.913, P=0.005), absence of prodromes(β=0.529, P=0.003) were independent risk factors for the prognosis of senile syncope. Conclusion Cardiac syncope is the most common cause of senile syncope in emergency department, with high recurrence and mortality. Age, coronary heart disease, cardiogenic syncope and no prodromal symptoms are the risk factors affecting the prognosis of patients.
Objective To observe the clinical features and long-term survival of elderly patients with emergency syncope, and to analyze the risk factors affecting the prognosis of elderly patients with syncope. Methods A total of 120 elderly patients with syncope admitted to Department of Emergency Medicine, Fogang county People's Hospital from Jan. 2017 to Jan. 2018 were selected to analyze the clinical characteristics of senile syncope, such as its causes, syncope types, symptoms and signs, disease outcomes. All patients were followed up for one year. The recurrence and death of syncope during the follow-up period were counted. Logistic regression was used to analyze the risk factor of influencing the prognosis of senile syncope patients. Results Of the 120 cases, 36 cases(30.00%) of reflex syncope, 43 cases(35.83%) of cardiogenic syncope, 31 cases(25.83%) of encephalogenic syncope, 2 cases(1.67%) of hypoglycemia, 3 cases(2.50%) of anemia, 5 cases(4.17%) of no abnormalities were found; 96 cases(80.00%) had no prodromal symptoms, 82 cases(68.33%) had better symptoms after emergency treatment, and 38 cases(31.67%) had no improvement.108 cases(90.00%) were followed up for one year, and during the follow-up period, the recurrence rate of syncope was 32.41%(35/108) and the mortality rate was 33.33%(36/108). Univariate analysis showed that the prognosis of senile syncope was related to age, sex, hypertension, coronary heart disease, syncope type, absence of prodromal symptoms and abnormal electrocardiogram(P<0.05). Logistic regression analysis showed that age ≥70 years old(β=-0.526, P=0.001), coronary heart disease(β=0.687, P<0.05), cardiogenic syncope(β=0.913, P=0.005), absence of prodromes(β=0.529, P=0.003) were independent risk factors for the prognosis of senile syncope. Conclusion Cardiac syncope is the most common cause of senile syncope in emergency department, with high recurrence and mortality. Age, coronary heart disease, cardiogenic syncope and no prodromal symptoms are the risk factors affecting the prognosis of patients.
引文
[1]曾元杰.动态心电图对老年心源性晕厥的诊断价值[J].中国数字医学, 2018, 13(11):41-43.
[2]马建斌,王东,王琦,等.晕厥患者发生晕厥后30d内死亡的危险因素探讨[J].中华急诊医学杂志, 2018, 27(6):672-678.
[3]刘文玲,胡大一,郭继鸿,等.晕厥诊断与治疗中国专家共识(2014年更新版)[J].中华内科杂志, 2014, 53(11):916-925.
[4]陈东昌,杨威,李江,等.变异型心绞痛晕厥与痉挛靶血管部位及心律失常的关系[J].中华实用诊断与治疗杂志, 2019, 33(3):250-253.
[5]中国生物医学工程学会心律分会,中国老年保健医学研究会晕厥分会,中国老年学和老年医学学会心血管病专业委员会,等.中国晕厥中心建设专家建议[J].中国循环杂志, 2019, 34(1):29-31.
[6]蔡高军,翁伟进,师干伟,等.直立倾斜试验在老年人不明原因晕厥中的临床应用[J].中国老年学杂志, 2016, 36(22):5723-5724.
[7]孙庆华,高丹,尹琳. 131例老年性晕厥的病因分析[J].中华老年心脑血管病杂志, 2016, 18(11):1178-1181.
[8]王坤,刘柱.老年晕厥的临床分析[J].淮海医药, 2014, 32(2):149-150.
[9]黄美娇,陈弹.老年人血管迷走性晕厥的研究进展[J].中华心血管病杂志, 2014, 42(6):534-536.
[10] RUWALD MH, HANSEN ML, LAMBERTS M, et al. The relation between age, sex, comorbidity, and pharmacotherapy and the risk of syncope:a Danish nationwide study[J]. Europace, 2012, 14(10):1506-1514.
[11]陈彦秋,何阳,李政亮,等.根本原因分析法在预防门诊患者晕厥管理中的运用[J].重庆医学, 2018, 47(7):991-992, 1008.
[12]于秋飞,杨颖,王婷.急诊晕厥83例临床分析[J].中国急救复苏与灾害医学杂志, 2018, 13(1):99-100.
[13]孟宜良,彭俊,来毅,等.老年性晕厥的病因及预后影响因素分析[J].中国全科医学, 2010, 13(8):899-900.
[14]梁继业,李爱华.老年性晕厥43例临床分析[J].中国实用医药,2012, 7(24):120-121.
[2]马建斌,王东,王琦,等.晕厥患者发生晕厥后30d内死亡的危险因素探讨[J].中华急诊医学杂志, 2018, 27(6):672-678.
[3]刘文玲,胡大一,郭继鸿,等.晕厥诊断与治疗中国专家共识(2014年更新版)[J].中华内科杂志, 2014, 53(11):916-925.
[4]陈东昌,杨威,李江,等.变异型心绞痛晕厥与痉挛靶血管部位及心律失常的关系[J].中华实用诊断与治疗杂志, 2019, 33(3):250-253.
[5]中国生物医学工程学会心律分会,中国老年保健医学研究会晕厥分会,中国老年学和老年医学学会心血管病专业委员会,等.中国晕厥中心建设专家建议[J].中国循环杂志, 2019, 34(1):29-31.
[6]蔡高军,翁伟进,师干伟,等.直立倾斜试验在老年人不明原因晕厥中的临床应用[J].中国老年学杂志, 2016, 36(22):5723-5724.
[7]孙庆华,高丹,尹琳. 131例老年性晕厥的病因分析[J].中华老年心脑血管病杂志, 2016, 18(11):1178-1181.
[8]王坤,刘柱.老年晕厥的临床分析[J].淮海医药, 2014, 32(2):149-150.
[9]黄美娇,陈弹.老年人血管迷走性晕厥的研究进展[J].中华心血管病杂志, 2014, 42(6):534-536.
[10] RUWALD MH, HANSEN ML, LAMBERTS M, et al. The relation between age, sex, comorbidity, and pharmacotherapy and the risk of syncope:a Danish nationwide study[J]. Europace, 2012, 14(10):1506-1514.
[11]陈彦秋,何阳,李政亮,等.根本原因分析法在预防门诊患者晕厥管理中的运用[J].重庆医学, 2018, 47(7):991-992, 1008.
[12]于秋飞,杨颖,王婷.急诊晕厥83例临床分析[J].中国急救复苏与灾害医学杂志, 2018, 13(1):99-100.
[13]孟宜良,彭俊,来毅,等.老年性晕厥的病因及预后影响因素分析[J].中国全科医学, 2010, 13(8):899-900.
[14]梁继业,李爱华.老年性晕厥43例临床分析[J].中国实用医药,2012, 7(24):120-121.