张健教授-晕厥-指南和临床幻灯片.ppt

* * * * 神经介导性晕厥的特点 分类 VVS CSS 发作 常见 少见 发作年龄 12-50岁 50 岁 前驱症状 有 无 心脏疾病 无 有 诊断 HUT CSM 反应类型 混合型(65%) 心脏抑制型 (60%) 血管抑制型 (25%) 混合型(20%) 心脏抑制型 (10%) 血管抑制型 (20%) 治疗 宣教及药物 起搏治疗 常需起搏治疗 Modified from Maloney et al., AHJ, 1994 多学科协作的必要性 神经介导 / 反射性晕厥 体位性低血压 心律失常 结构性心脏病 脑血管 (窃血综合征) 1 3 2 其他： TLOC / 癫痫发作 精神因素的TLOC 神经科 心血管科 内科 心理学科 2009 ESC 晕厥指南要点 ESC 2009 指南更新 强调了真正的晕厥与TLOC的区别 总结了晕厥的关键原因 指出了提高诊断效力，提高效价比的方法 恰当的诊断和治疗路径 关注结构的变化 危险分层降低住院率 晕厥单元的建立 多学科协作的理念 * * * * * Syncope should be considered as a symptom not as a diagnosis. The basis of syncopal symptoms should be sought through careful evaluation. Only after a cause is established can an effective treatment regimen be developed. * Syncope should be considered as a symptom not as a diagnosis. The basis of syncopal symptoms should be sought through careful evaluation. Only after a cause is established can an effective treatment regimen be developed. * Syncope should be considered as a symptom not as a diagnosis. The basis of syncopal symptoms should be sought through careful evaluation. Only after a cause is established can an effective treatment regimen be developed. * * This slide provides a simple classification of the principal causes of syncope. This scheme lists the causes of syncope from the most commonly observed (Left) to the least common (Right). This ranking may be helpful in thinking about the strategy for evaluating syncope in individual patients. Within the boxes,the most common causes of syncope are indicated for each of the major diagnostic groups. The numbers at the bottom of each column provide an approximate value for the average frequency (Kapoor 1998) with which that category appears in published reports summarizing diagnostic findings. It should be noted that orthostatic causes are not often referred to specialists and consequently tend to be under represented in the literature. * * Syncope should be considered as a symptom not as a diagnosis. The basis of