電子記錄系統於不明原因昏厥診斷之運用

Application of Electronic Recording Systems in Patients with Syncope

游治節(Chih-Chieh Yu)

《台灣醫學》 23卷5期 (2019/09) Pp. 603-607

https://doi.org/10.6320/FJM.201909_23(5).0005

摘要

昏厥是很多不同疾病的共通表現，病因可能是很良性的迷走神經性昏厥，也有可能是會導致猝死的心因性昏厥，醫師的工作就是要把這一群心因性昏厥的病人診斷出來，給予適當的治療，然而昏厥的發生來得快，去得也快，昏厥過後常常作完所有的檢查也找不出病因，因此，智慧型心電圖紀錄器就有它的角色。然而不同的紀錄器有不同的紀錄方式、紀錄時間、價錢等等需要考量，植入型的紀錄器還要考量植入帶來的風險，醫師應對所有可取得的紀錄器作全整的了解，才能提供病人完整的資訊以供選擇。

關鍵字

昏厥 ； 猝死 ； 智慧型心電圖紀錄器 ； 心律不整

並列摘要

Syncope is a common presentation of different diseases. The severity of the underlying disease can be very diverse, from the most benign course of vasovagal syncope to the most malignant course of cardiogenic syncope. The attending physician should try to clarify the underlying etiology of the syncope so that proper treatment can be given. However, the underlying etiology of syncope sometimes is very difficult to determine. All the examinations done after the syncope episode can be completely normal. Therefore, it is eminently important to record the electrocardiogram during syncope. There are now many different kinds of recording methods, including Holter, wearable ECG recorder, patch-based loop recorder, or implantable loop recorder. The attending physicians should be aware of the different advantages and disadvantages of these methods, as well as the cost and the benefit, so that they can give the patients a comprehensive suggestion to help identify the etiology and give the patients the best treatments.

並列關鍵字

syncope ； sudden death ； arrhythmia ； loop recorder

參考文獻

Brignole M, Moya A, de Lange FJ, et al: 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J 2018;39:1883-948.

Priori SG, Blomström-Lundqvist C, Mazzanti A, et al: 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015;36:2793-867.

Lin M, Wolfe RE, Shapiro NI, et al: Observation vs admission in syncope: can we predict short length of stays? Am J Emerg Med 2015;33: 1684-6.

Thiruganasambandamoorthy V, Stiell IG, Wells GA, et al: Outcomes in presyncope patients: a prospective cohort study. Ann Emerg Med 2015;65:268-76.e6.

McKeon A, Vaughan C, Delanty N: Seizure versus syncope. Lancet Neurol 2006;5:171-80.