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目的探讨置入式Holter(ILR)在诊断不明原因晕厥和指导治疗中的临床价值。方法入选2002年10月至2005年5月求治的不明原因晕厥患者10例,男性4例,女性6例,平均年龄(41±22)岁。有2次以上晕厥或近似晕厥史平均为(4.5±1.4)次/例,经常规检查未能明确晕厥原因。均选用Medtronic公司RevealPlus(9526型ILR。结果10例患者平均随访(17.8±6.6)个月,ILR有效监测时间平均(15.3±3.6)个月,监测期内6例患者再发晕厥或近似晕厥24次。7例患者手动触发19段心电图,ILR自动触发记录460段心电图,共记录211段心电图为心律失常事件。根据症状-心律相关性,7例患者明确为心律失常性晕厥,1例患者明确为非心律失常性晕厥;2例仍不能明确晕厥原因。提示ILR诊断晕厥的效率为80%。10例依据ILR监测结果得到相应治疗,晕厥发作减少或消失。结论ILR用于诊断不明原因晕厥和先兆晕厥安全、高效、长程,可证实或排除患者的部分晕厥或近似晕厥系心律失常所致;具有微创、简单、监测期长、信息量大等优点,可作为现有晕厥诊断方法的重要补充。加强患者的依从性和动态优化工作参数,将进一步提高ILR的诊断价值。
Objective To investigate the clinical value of Holter (ILR) in the diagnosis of unexplained syncope and guide therapy. Methods Ten patients with unexplained syncope were enrolled from October 2002 to May 2005. There were 4 males and 6 females with an average age of (41 ± 22) years. There are more than 2 syncope or syncope of the average history of (4.5 ± 1.4) times / case, the conventional examination failed to clear the cause of syncope. Medtronic’s RevealPlus (9526 ILR) was used.Results The average follow-up time of 10 patients was (17.8 ± 6.6) months, and the effective monitoring time of ILR was (15.3 ± 3.6) months on average. During the monitoring period, 6 patients had recurrent syncope or syncope 24 .7 patients were manually triggered 19 electrocardiogram, ILR automatically trigger recording 460 ECG, a total of 211 recorded electrocardiogram arrhythmia events.According to the symptoms - heart rhythm correlation, 7 patients were clearly arrhythmia syncope, 1 patient was clear Non-arrhythmic syncope; 2 cases still can not clear the cause of syncope, suggesting that ILR diagnosis of syncope efficiency was 80% .10 cases were treated according to ILR monitoring results, reduce or disappear syncope episode.Conclusion ILR for the diagnosis of unexplained syncope and Prosthetic syncope is safe, efficient and long-range, can confirm or exclude some of the patients syncope or similar syncope caused by arrhythmia; with minimally invasive, simple, long monitoring period, large amount of information, etc., can be used as an important diagnostic method of syncope Supplement to strengthen patient compliance and dynamically optimize the working parameters, will further improve the diagnostic value of ILR.