摘要
昏厥為病人常見的主訴，昏厥原因有許多可能，所以昏厥的機轉及治療不時的被提出來討論。美國心臟學會（ACC/AHA/HRS）和歐洲心臟學會（ESC）分別在2017年及2018年針對昏厥發表指引，在昏厥的相關治療也提出了新的見解。當遇到意識不清的病人時，首要目標是鑑別「是否為昏厥病人」，可以使用昏厥及癲癇症狀比較表格來做簡單區分；後續依照病史、理學檢查及心電圖確認為昏厥後，再用「昏厥評估整合分數（EGSYS）」分為心因性或神經性，並利用「ESC2018風險評估量表」來判斷病人動向是住院、留院觀察抑或門診追蹤。當懷疑心因性昏厥時，建議執行心臟超音波，但不須常規施作二十四小時心電圖。後續針對個別疾病作檢查及治療。
並列摘要
Syncope was a usual complaint, especially in elderly. There are multiple reasons to cause syncope and it should be well discussed for not only etiology nor treatment plan. Multiple articles had new recommendations of syncope. Furthermore, ACC/AHA/HRS and ESC had published syncope guideline recently and provide us new thought for syncope treatment. First thing first, when encounter a patient with loss of conscious, we should identify whether it's a syncope episode or note. Careful physical examination can help us to distinguish syncope and non-syncope episode. Furthermore, electrocardiogram is a decisional step for differentiating cardiac syncope or non-cardiac syncope. We also could assist with evaluation of guidelines in syncope study (EGSYS) score. Moreover, risk evaluation can help us to made the decision of patient disposition, whether admission, observation or discharge. When under the impression of cardiac syncope, cardiac echo was suggested. However, routine 24-hour-holter examination was not recommendation. (flowchart 1: syncope flowchart)
並列關鍵字
無資料延伸閱讀
- 謝育整、林俊立（2019）。昏厥診斷的多樣性。台灣醫學，23(5)，596-602。https://doi.org/10.6320/FJM.201909_23(5).0004
- 李燕鳴（2021）。暈厥在基層醫療之評估。家庭醫學與基層醫療，36(1)，22-31。https://www.airitilibrary.com/Article/Detail?DocID=P20090727001-202101-202101280013-202101280013-22-31
- 陳郁安、張坤正（2019）。心律不整性昏厥之診斷與治療。台灣醫學，23(5)，614-621。https://doi.org/10.6320/FJM.201909_23(5).0007
- 游治節（2019）。電子記錄系統於不明原因昏厥診斷之運用。台灣醫學，23(5)，603-607。https://doi.org/10.6320/FJM.201909_23(5).0005
- Liao, C. K., Lin, C. S., & Peng, C. C. (2018). Diagnosing Emergency Causes of Syncope, RUSH Based Approach. Journal of Acute Medicine, 8(3), 132-134. https://doi.org/10.6705/j.jacme.201809_8(3).0007