透過您的圖書館登入
IP:3.238.57.9
  • 學位論文

迷走神經性昏厥與頭抬高傾斜床試驗

Vasovagal syncope and Head up tilt table test

指導教授 : 張文正
共同指導教授 : 陳穆寬
若您是本文的作者,可授權文章由華藝線上圖書館中協助推廣。

摘要


研究動機研究重要性: 昏厥十分常見,有百分之二十到百分之五十的成人一生中曾經歷過至少一次的昏厥,昏厥必須與眩暈、昏迷、癲癇、頭暈、心因性猝死作鑑別診斷; 而眩暈與頭暈是耳鼻喉科門診常見症狀。血管迷走神經性昏厥是昏厥最常見的原因,雖然危險程度較低且有較好的預後,但發生年齡愈高卻有不好的預後,目前最常用來診斷血管迷走神經反應的方式是頭抬高傾斜試驗(head-up tilt test); 測試被用來評估無法解釋原因的昏厥病人。本研究亦可提供頭抬高傾斜試驗與臨床症狀相關性預測,及頭抬高傾斜試驗與身體質量相關,以為診斷參考。 研究方法與對象: 本研究採方便取樣,選定之研究受試者均來自醫院中區一醫學中心,心臟專科醫師安排此項檢查之患者,自93年7月至98年,共計有93名病患參與本研究,執行傾斜床試驗。描述性資料含研究對象基本資料,含:性別、年齡、疾病特性、血壓、心跳、身體質量,以百分比、平均值及標準差描述研究其分佈情形; 分為頭抬高傾斜試驗陽性組、頭抬高傾斜試驗陰性兩組,比較頭抬高傾斜試驗陽性反應及陰性反應兩組基準心跳、血壓有無差異,以t-test檢定; 頭抬高傾斜試驗陽性反應及陰性反應臨床症狀以卡方檢定; 頭抬高傾斜試驗陽性反應及陰性反應與臨床症狀多寡以卡方檢定。 結果: 共計有93名病患參與:男性41名女性52名平均年齡(53.29±18.85) 身高(161.7±8.74)體重(62.99±11.62) 患者全部進行BHUT檢查,陽性率為1%(1/93)。陰性患者中對92例進行SNHUT檢查,陽性率為67%(62/92) 兩組在性別、年齡、疾病特性、心跳並無顯著差異,臨床症狀中與噁心、嘔吐、心悸單一症狀並無顯著相關,而與眩暈有關(p=0.022) ,但頭抬高傾斜試驗陽性與臨床症狀多者有相關(p=0.001) 兩組在第六分鐘血壓、體重及身體質量確有差異(p<0.05) 身體質量並不影響檢查結果。 結論: 本研究發現頭抬高傾斜試驗陽性組身體質量國人(23.27±3.08)遠低於國外(36.9±3.9) ; 臨床症狀 以眩暈表現確實可預測頭抬高傾斜試驗陽性,與國外研究相符。頭抬高傾斜試驗除了對迷走神經性暈厥有重要診斷價值外,臨床症狀多者至少一項以上的患者中的診斷價值也值得重視。

並列摘要


Syncope is very common, and 20% to 50% of adults have experienced at least one times of syncope, syncope with dizziness, coma, seizures, dizziness. Cardiogenic cause is considered as a result of the differential diagnosis of sudden death. Vertigo and dizziness are common symptoms of ear-nose-throat clinic. Vasovagal syncope is the most common causes of syncope, although lower degree of risk and better prognosis, but the higher age has not occurred in the prognosis. The current test used to diagnose vasovagal reaction is the first elevation tilt test (head-up tilt test); the test was used to assess the causes of unexplained syncope. This study will also provide the tilt table test in their first time and predict the relevance of clinical symptoms, and head up tilt test, body mass associated with that diagnosis reference. Research Methods and Objects: In this study, convenience sampling, the study subjects were selected from the hospital in a medical center district, the heart specialist arrangements for the inspection of the patients, from July, 2004 to March, 2009, a total of 93 patients participated in this study tilt test implementation. Descriptive information on subjects including of gender, age, disease characteristics, blood pressure, heart rate, body mass, percentage, average and standard deviation to describe the distribution of study. Head up tilt table test is divided into positive, head up tilt table test negative for the two groups to compare up tilt test, the first positive and negative response to two sets of baseline heart rate, blood pressure difference between whether or not to test t-test; head up tilt test, positive and negative symptoms in chi-square test; head up tilt test, positive and negative reactions and clinical symptoms in the amount of chi-square test. Results: A total of 93 patients to participate: 41 males 52 females mean age (53.29 ± 18.85) Height (161.7 ± 8.74) body weight (62.99 ± 11.62) for patients with all BHUT examination, the positive rate of 1% (1 / 93 ). Negative patients to 92 cases of SNHUT examination, the positive rate was 67% (62/92) the two groups in terms of gender, age, disease characteristics, no significant differences in heart rate, clinical symptoms with nausea, vomiting, heart palpitations do not have a single symptom significantly correlated with the vertigo-related (p = 0.022), but head up tilt table test positive with clinical symptoms are related to more (p = 0.001) groups in the sixth minute of blood pressure, weight and body mass do have differences (p <0.05) body mass does not affect the test results. Conclusion: This study found that head up tilt testing positive people body mass (23.27 ± 3.08) much lower than abroad (36.9 ± 3.9); clinical symptoms to the performance of true vertigo predictable positive head up tilt table test, and study abroad line. Head up tilt test, in addition to vagal syncope has important diagnostic value, clinical symptoms were at least one more than the diagnosis of patients also deserved attention.

參考文獻


1. 方識欽, 陳威宏, 邱浩彰.神經性暈厥症的診斷:同步多元化監測的傾斜床測驗.臺灣醫學第五卷第六期615-622頁
2. 吳盈光, 杜明勳. 常見昏厥及其評估 基層醫學第二十二卷第一期 28-34頁
75. Thimas H. Miller. Jerry E. Kruse, M.S.P.H. Evaluation of Syncope American Family Physician 2005; 72( 8): 1492-1550
3. 吳仁傑,陳坤詮. 頭暈之評估與處置 慈濟醫學雜誌第十七卷第五 期35-40頁
10. Barbara Zahorska-Markiewicz, Katarzyna Mizia-Stec, Ewa Jastrzebska-Maj, Tadeusz Mandecki, Teresa Bilewicz-Wyrozumska, Zbigniew Mucha and Zbigniew Gasior Tilt table testing in obesity International Journal of Cardiology 2003; 88(1),43-48

被引用紀錄


陳俊安(2011)。利用血流動力學及自律神經檢查提早發現迷走神經性昏厥〔碩士論文,臺北醫學大學〕。華藝線上圖書館。https://doi.org/10.6831%2fTMU.2011.00138

延伸閱讀