Syncope(1)

晕厥(1)

James C. Chesnutt

Syncope is a common and concerning medical problem, which accounts for 3% of emergency room visits and up to 6% of hospital admissions. Although the cause of syncope can be life-threatening (e.g., ventricular tachycardia) and the result can be devastating (e.g., fractured hip), a definitive explanation for syncope is found less than one half of the time. Syncope recurrence is approximately 20% per year compared with an incidence of 2% for an initial episode of syncope.

晕厥是一种令人担忧的常见病，占急诊病例的3%，住院病例中可达6%。虽然晕厥的病因可能危及生命（如室性心动过速)，并会产生严重后果（如髋部骨折)，但说得清楚的晕厥却不到一半。晕厥的复发率大约为20%年，初发率则为2%。

1. Approach.

1、诊断思路

Syncope is a brief loss of consciousness with collapse resulting from transient brain dysfunction based on decreased blood flow or neurologic insult. Syncope can be categorized based on the causative mechanism (See Table below). The most common causes are vasovagal (18%), arrhythmia (14%), neurologic (10%), orthostatic hypotension (8%), and situational (5%).

晕厥是暂时性意识丧失并跌倒，它是因为血流减少或神经损伤而造成一过性大脑功能失调而引起的。根据诱发机制，晕厥可以分为几类。从诱因看，最常见的有血管迷走神经性（占18%)、心率不齐性（14%)、神经性（10%)、直立性低血压性（8%)和环境因素引起的晕厥（5%)。

Types of syncope with selected examples

晕厥分类及举例

CARDIOGENIC SYNCOPE (CS)

1. Arrhythmia, including ventricular tachycardia, sick sinus syndrome, atrial fibrillation, atrioventricular block and others
2. Organic heart disease, including coronary artery disease congestive heart failure valvular disease, hypertrophic cardiomyopathy, and others.医学全在线www.med126.com

心源性晕厥（CS)

1. 心律失常，包括室性心动过速、病窦综合症、房性纤颤、房室传导阻滞，其他。
2. 器质性心脏病，包括冠状动脉疾病、充血性心力衰竭、心脏瓣膜疾病、肥厚性心肌病，其他。

NEUROGENIC SYNCOPE (NS)

1. Seizure disorder
2. Transient ischemic attack and stroke
3. Subclavian steal syndrome and others

神经性晕厥（NS)

1. 癫痫。
2. 一过性脑缺血发作和脑卒中。
3. 锁骨下动脉窃血综合征及其他。

NEUROCARDIOGENIC SYNCOME (NCS)

1. Vasovagal
2. carotid sinus hypersensitivity
3. Orthostatic hypotension
4. Dysautonomic
5. Postural orthostatic tachycardia syndrome
6. Situational, including micturition, cough, and others

神经心源性晕厥（NCS)

1. 血管迷走神经性。
2. 颈动脉窦过敏。
3. 直立性低血压。
4. 自主神经功能紊乱。
5. 体位性心动过速综合症。
6. 环境因素，包括排尿、咳嗽，其他。

UNCLASSIFIED SYNCOPE

1. Drugs
2. Alcohol
3. Psychogenic
4. Hypoglycemia
5. Pregnancy
6. Hypoxemia, dehydration, and others

未分类晕厥

1. 药物。
2. 酒精。
3. 心理因素。
4. 低血糖。
5. 妊娠。
6. 低氧血症，脱水及其他。

2. History

2、病史检查

What are the symptoms or circumstances related to the syncope?

1. Dizziness preceding syncope is highly associated with a psychological cause (24%) versus syncope without preceding dizziness (5%). Dizziness with syncope can also be associated with arrhythmia.
2. Important history includes palpitation, duration of prodrome and recovery, and presence of postural or exertional symptoms.
3. Related environmental factors include heat, dehydration, and alcohol.

1. 与无头晕性晕厥相比，头晕后晕厥与精神性诱因关联很大，前者占5%，后者则占24%。头晕伴晕厥也与心律不齐有关。
2. 重要病史包括：心悸、前驱症状及恢复时间、以及体位性或劳力性症状。
3. 相关环境因素包括：高温、脱水和酒精。

Which disease, risk factor, or family history is present?

1. Organic heart disease is associated with arrhythmia and increased risk of death.
2. Psychiatric illnesses most commonly associated with syncope are major depression (12.2%), alcoholism (9.2%), generalized anxiety disorder (8.6%), and panic disorder (4.3%). These correlate with a higher rate of recurrent syncope, younger age, and a more benign course.
3. Older age (>60 years) is more highly associated with arrhythmias, orthostatic hypotension, medication side-effects, and situational (e.g., micturition) syncope.
4. Ask about diabetes mellitus, neuropathy, anemia, and other chronic diseases.
5. Inquire about a family history of sudden death, hypertrophic cardiomyopathy, or other organic heart disease.

1. B. 疾病、危险因素及家族史

1. 器质性心脏病可伴随心律不齐和死亡危险增加。
2. 与晕厥最有关系的精神疾病包括严重的抑郁（12.2%)、酒精中毒（9.2%)、全身性焦虑（8.6%)和恐惧病（4.3%)。上述疾病通常与较高的晕厥复发率、年幼和较为良性的病程有关。
3. 老龄病人（＞60岁)与心律不齐、直立性低血压、药物副作用和环境性（如排尿)晕厥关联更大。
4. 询问糖尿病、神经病、贫血和其他慢性病。
5. 查询卒死、肥厚性心肌病及其他器质性心脏病的家族史。

What medications does the patient take?

The most commonly implicated are antihypertensives and antidepressants. Others include antianginals, analgesics, and sedatives.

病人用药

最常见的影响药物有降压药和抗抑郁剂。其他药物包括抗心绞痛药、麻醉剂和镇静剂。