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心源性晕厥的诊断和评估OA

THE DIAGNOSIS AND ASSESSMENT OF CARDIAC SYNCOPE

中文摘要英文摘要

目的:通过参阅文献,从临床实践的角度出发,依据病理机制和病因学选择心源性晕厥的诊断手段,依据回顾性分析中得到的各项诊断指标的效能参数制定出合理的诊断程序;通过前瞻性队列研究评价该诊断程序的合理性、科学性及其综合诊断效能。以期提高心源性晕厥人群的诊断效率,降低诊断成本。方法本研究对2010~2012年间就诊于我院的328例晕厥患者进行了回顾性研究,其中83例经过严格而细致的检查并进行了1~3年(平均1.57年)的随访获得心源性晕厥诊断。对回顾性研究中各项不同的诊断指标进行评估,得到不同诊断指标的评价参数(例如敏感性、特异性、阳性预测值、阴性预测值等),根据不同病因和机制的制定出有针对性的诊断程序,并在2012~2014年间进行前瞻性研究,对序贯进入我院就诊的345例晕厥患者根据回顾性研究中制定的诊断程序进行诊断,同时对入组患者中出现二次晕厥的患者(包括已经明确诊断的患者和未曾明确的患者)重复采用诊断程序进行诊断,进一步验证诊断程序的诊断效能。结果345例晕厥患者经过整个诊断程序可明确诊断患者为295例,85.51%;50例为诊断不明,占14.49%。最常见的病因为血管迷走性晕厥共182例,占61.69%;其次为心源性晕厥共85例,占24.63%;16例为精神性晕厥,占5.42%;12例为代谢性晕厥,占4.06%。12例不明确诊断的二次晕厥患者中,有 6例明确了诊断,均为血管迷走性晕厥。20例明确诊断的二次晕厥患者中,18例依旧明确为之前诊断,2例为心源性晕厥新增合并血管迷走性晕厥。结论该心源性晕厥诊断程序能较好及较早的协助明确心源性晕厥的诊断且重复性良好,建立简单、高效、廉价的心源性晕厥诊断程序并将其运用于临床工作,可有效地提高心源性晕厥的病因学诊断率从而有利于及时对病人进行治疗和抢救。

Objective Cardiac syncope is a dangerous disease which lead to high mortality.The best way to reduce the mortality of syncope is diagnose it as soon as possible.So a efficient and inexpensive diagnostic program has a great meaning for the Cardiac syncope patients.On the basis of authority papers and the require of clinical,we choose some inspection items to diagnose the syncope patients.Then we make a review study to assess the veracity of those inspection items.Finally,we devise a diagnostic program and make use of a queue research to test the diagnostic program.Methods We make a review study for 328 patients who receive treatment during 2010 -2012.Got through 1 -3years(average1.7year) follow -up visit,83 patients were diagnosed as Cardiac syncope.After assess the inspec-tion items,we devise a diagnosis flow path and make use of a queue research to checking the diagnosis flow path dur-ing 2012 -2014.There are altogether 345 patients take part in this diagnosis flow path..Results By use this diag-nosis flow path,there are 295 patients were diagnosed as syncope,which take 85.51% of totality and still have 14. 49% of totality can not be diagnosed at the end.which the number is 50.During the 295 patients,there are 182 pa-tients are vasovagal syncope、85 patients are cardiac syncope 、 16 patients are spirituality syncope and 12 patients are Metabolic syncope.They take percentage of totality respectively are 61.69%、30.02%、5.42%、4.06%.Conclusion The diagnosis flow path can make the diagnose of the Cardiac syncope more efficient and inexpensive and this diagnosisflow path will make great help for the diagnose and treat of Cardiac syncope patients.

杨旭丽;高虹;罗韶金;薛世荣;黄小琼;潘志信;蒋子裕

佛山市南海区人民医院 广东佛山 528200

晕厥诊断程序;心源性晕厥;诊断效能

Cardiac syncope;diagnostic program;diagnostic efficiency

《现代医院》 2015 (001)

71-74 / 4

2012年佛山市医学类科技攻关项目(编号201208152)

10.3969/j.issn.1671-332X.2015.01.027

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