神经介导的反射性晕厥
小结
定义
病史和体格检查
其他诊断因素
- 复发性晕厥病史
- 无结构性心脏病
- 激发因素
- 恶心
- 眩晕
- 苍白
- 发汗
- 视力或听力下降
- 躯体损伤
- 发作后疲乏
- 心悸
- 心动过缓
- 无猝死家族史
- 神经痛
危险因素
- 既往晕厥
- 心律失常、心肌梗死、心力衰竭或心肌病既往病史
- 重度主动脉瓣狭窄
- 长期站立
- 情绪应激（尤其在温热的拥挤环境中）
- 脱水/低血容量
- 曾出现恶心和/或呕吐
- 曾出现严重疼痛
诊断性检查
首要检查
- 12 导联心电图
- 血清血红蛋白
- 血浆血糖
- 血清 β-hCG（人绒毛膜促性腺激素）
- 心肌酶
- D-二聚体
- 血清皮质醇
- 尿素或血清肌酐
需考虑的检查
- 超声心动图
- 倾斜试验
- 颈动脉窦按摩 (CSM)
- 插入式循环记录器
- 电生理学检查
- 咽鼓管捏鼻鼓气法
- 主动站立试验
- 冷加压试验
- 咳嗽试验
新兴检查
- 三磷酸腺苷 (ATP) 试验
治疗流程
血管迷走性晕厥
情境性晕厥
颈动脉窦综合征
撰稿人
作者
Bryant Lin, MD
Clinical Assistant Professor of Medicine
Division of Primary Care and Population Health
Stanford University School of Medicine
Stanford
CA
利益声明
BL declares that he has no competing interests.
Paul J. Wang, MD, FACC, FHRS
Professor of Medicine
Stanford Arrhythmia Service
Stanford University School of Medicine
Stanford
CA
利益声明
PJW receives fellowship support, honoraria, and clinical trial support from Medtronic, which manufactures LINQ, an implantable loop recorder.
鸣谢
Dr Bryant Lin and Dr Paul J. Wang would like to gratefully acknowledge Dr David G. Benditt and Dr John T. Nguyen, previous contributors to this topic.
利益声明
DGB has consultant and equity positions: Medtronic Inc., St Jude Medical Inc., Transoma Inc., Cardionet Inc. DGB is also an author of several references cited in this topic. JTN declares that he has no competing interests.
同行评议者
Sanjiv Petkar, MBBS, MD, DM (Cardiology), MRCP
Consultant Cardiologist
Hull and East Riding of Yorkshire NHS Trust
Castle Hill Hospital
East Yorkshire
UK
利益声明
SP has received sponsorship in the past from Medtronic, Inc. and St Jude Medical, Inc. for attending conferences. He has received speaker's fees from Medtronic, Inc. In addition, he was in receipt of a research grant from Medtronic, Inc. to the University of Manchester.
Kenneth A. Ellenbogen, MD
Kontos Professor of Cardiology
Medical College of Virginia
Richmond
VA
利益声明
KAE declares that he has no competing interests.
Andrew Parfitt, MBBS, FFAEM
Clinical Director
Acute Medicine
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident Emergency Medicine
St Thomas' Hospital
London
UK
利益声明
AP declares that he has no competing interests.
鉴别诊断
- 直立性晕厥（体位或直立不耐受性晕厥综合征）
- 心动过缓
- 心动过缓：房室传导障碍
更多 鉴别诊断指南
- 对于可能导致短暂性意识丧失的疾病，推荐倾斜试验和其他激发性心血管自主神经试验
- 关于晕厥评估和管理的临床实践更新。
更多 指南患者教育信息
何为心房颤动？
心房颤动：如何有效治疗？
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明