CAJ | 학술논문

目的探讨直立倾斜试验(HUTT)阳性反应出现后患者心律失常发生的特征.方法分析2001年3月至2009年8月在基础直立倾斜试验(BHUT)或舌下含化硝酸甘油倾斜试验(SNHUT)阳性反应出现后发生心律失常的169例患者资料,男性57例,女性112例,年龄6～65(23.1±14.8)岁,儿童(<18岁)86例,成人(≥18岁)83例.结果心律失常发生在BHUT和SNHUT阳性反应后的患者分别为75例(44.38%)、94例(55.62%).常见类型为窦性心动过缓(143例,84.62%)、交界性逸搏心律(55例,32.54%)、窦性停搏(26例,15.38%),其中窦性心动过缓在成人更多见(P<0.01),窦性停搏和交界性逸搏心律的发生无年龄、性别和试验方式差别;心律失常与晕厥或接近晕厥的临床表现几乎同时出现者为77例(45.56%)、滞后出现者92例(54.44%),并且前者多发生在BHUT中,后者多发生在SNHUT中(P<0.05);心律失常与血压下降几乎同时出现者为84例(53.50%),滞后出现者73例(46.50%),且前者多发生在BHUT中,后者多发生在SNHUT中(P<0.01).结论 (1)HUTT阳性反应发生后常见心律失常为窦性心动过缓、交界性逸搏心律和窦性停搏,窦性停搏的发生无年龄、性别和试验方式的差别,试验操作中需提高警惕;(2)BHUT中,心律失常多与晕厥或接近晕厥的表现、血压的下降同时发生;SNHUT中,心律失常多发生于晕厥或接近晕厥的表现和血压下降之后,可能与硝酸甘油药理作用有关.
목적 탐토직립경사시험(HUTT)양성반응출현후환자심률실상발생적특정.방법 분석2001년3월지2009년8월재기출직립경사시험(BHUT)혹설하함화초산감유경사시험(SNHUT)양성반응출현후발생심률실상적169례환자자료,남성57례,녀성112례,년령6～65(23.1±14.8)세,인동(<18세)86례,성인(≥18세)83례.결과 심률실상발생재BHUT화SNHUT양성반응후적환자분별위75례(44.38%)、94례(55.62%).상견류형위두성심동과완(143례,84.62%)、교계성일박심률(55례,32.54%)、두성정박(26례,15.38%),기중두성심동과완재성인경다견(P<0.01),두성정박화교계성일박심률적발생무년령、성별화시험방식차별;심률실상여훈궐혹접근훈궐적림상표현궤호동시출현자위77례(45.56%)、체후출현자92례(54.44%),병차전자다발생재BHUT중,후자다발생재SNHUT중(P<0.05);심률실상여혈압하강궤호동시출현자위84례(53.50%),체후출현자73례(46.50%),차전자다발생재BHUT중,후자다발생재SNHUT중(P<0.01).결론 (1)HUTT양성반응발생후상견심률실상위두성심동과완、교계성일박심률화두성정박,두성정박적발생무년령、성별화시험방식적차별,시험조작중수제고경척;(2)BHUT중,심률실상다여훈궐혹접근훈궐적표현、혈압적하강동시발생;SNHUT중,심률실상다발생우훈궐혹접근훈궐적표현화혈압하강지후,가능여초산감유약리작용유관.
Objective To study the characteristics of arrhythmia after a positive head-up tilt table test (HUTT). Methods Head-up tilt table test (BHUT) or sublingual nitroglycerin-provocation head-up tilt table test (SNHUT) were performed in 1374 patients at the Second Xiangya Hospital of Central South University from March of 2001 to August of 2009. Arrhythmias were recorded in 169 patients after a positive HUTT [57 male, age 6 - 65 years, 86 children < 18 years, mean age (23. 1 ± 14. 8) years]. Results Arrhythmias developed in 75 patients (44.38%) post a positive BHUT and in 94 patients (55.62%) post a positive SNHUT. Major types of arrhythmias were sinus bradycardia ( 143/169, 84. 62% ), junctional escape rhythm (55/169, 32.54%) and sinus arrest (26/169, 15. 38% ). Sinus bradycardia was more common in adult (P < 0. 01 ). Occurrence of junctional escape rhythm and sinus arrest was not affected by age, gender and test mode. Arrhythmia and the manifestation of syncope or pre-syncope occurred simultaneously in 77 (45.56%) patients and mainly in BHUT, while arrhythmia appeared later than the syncope manifestation in 92 (54.44%) patients and mainly in SNHUT (P <0. 05). Arrhythmia and blood pressure reduction occurred simultaneously in 84 (53.50%) cases and mainly in BHUT, while arrhythmia appeared later than reduction of blood pressure in 73 (46. 50% ) cases and mainly in SNHUT (P<0. 01 ).Conclusions ( 1 ) The common types of arrhythmia were sinus bradycardia, junctional escape rhythm and sinus arrest after a positive HUTT. Occurrence of sinus arrest was not affected by age, gender and test mode. (2)In BHUT, arrhythmia occurred mostly simultaneously with the manifestation of syncope or presyncope and blood pressure reduction, while arrhythmia appeared later in SNHUT.