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目的:通过观察排尿性晕厥(MS)患者在直立倾斜试验中发生晕厥时心率、血压以及心率变异性(HRV)的变化,探讨MS的发病机制并对临床治疗提出新的思路。方法:对16例MS患者及20例健康者行基础直立倾斜试验和硝酸甘油诱发直立倾斜试验。试验全程行无创血压、心电监测,每3min行HRV分析。结果:16例MS患者中6例出现阳性反应,晕厥前心率达到最高,平均为(105.67±19.68)次/min,晕厥时心率比最高心率下降了(50.32±12.5)%,而SBP、DBP、MAP分别下降了(17.62±4.65)%、(16.87±6.31)%、(17.27±4.96)%。健康对照组无一例发生阳性反应。HRV分析发现,倾斜70°后,阳性反应组低频段功率标化值(LFn)和低频与高频功率标化值(HFn)的比值(LFn/HFn)均增大,HFn减小;晕厥前或结束前LFn和LFn/HFn值升至最高,HFn降至最低;晕厥时LFn与LFn/HFn急剧下降,而HFn迅速升高。健康对照组试验过程中仅有LFn与LFn/HFn的轻微变化,且与倾斜试验开始前基础状态相比差异无统计学意义。结论:MS的发生与自主神经调节功能障碍(迷走神经过度兴奋、交感神经张力不足)密切相关。在积极预防MS发作的基础上加用抗胆碱药物和自主神经调节药物,可望取得一定疗效。
Objective: To observe the changes of heart rate, blood pressure and heart rate variability (HRV) during syncope in patients with urinary syncope (MS) and to explore the pathogenesis of MS and put forward new ideas for clinical treatment. Methods: Twenty-six patients with MS and 20 healthy subjects underwent tilt-up test and nitroglycerin-induced upright tilt test. Non-invasive blood pressure throughout the test line, ECG monitoring, HRV analysis every 3min line. Results: Six of 16 MS patients showed a positive response, with a mean of (105.67 ± 19.68) beats / min before the onset of syncope. The heart rate decreased by 50.32 ± 12.5% MAP decreased by (17.62 ± 4.65)%, (16.87 ± 6.31)% and (17.27 ± 4.96)%, respectively. None of the healthy controls had a positive reaction. HRV analysis showed that LFn and LFn ratios (LFn / HFn) increased and HFn decreased in the positive reaction group after tilting 70 °. Before the onset of syncope Or before the end of LFn and LFn / HFn values rose to the highest, HFn down to a minimum; LFn and LFn / HFn sharp decline in syncope, while HFn increased rapidly. There were only slight changes of LFn and LFn / HFn in the healthy control group during the test, and there was no significant difference compared with the baseline state before the start of the tilt test. Conclusion: The occurrence of MS is closely related to autonomic dysfunction (vagal hyperexcitability and insufficient sympathetic tone). In the active prevention of MS episodes based on the use of anticholinergic drugs and autonomic regulation drugs, is expected to achieve a certain effect.