晕厥新课件演示.ppt

Prevention of Syncope Trial (POST) 多中心、随机、对照 208名既往迷走晕厥史 应用美托洛尔 25-100mg/d 随访1年 美托洛尔和安慰剂组的晕厥发生率无差异 Sheldon.Circulation.2006;1164 晕厥的预防试验 (POST) 美托洛尔 vs. 安慰剂 血管迷走性晕厥 最近的起搏器治疗随机试验 Selection criteria vary Binary vs time to first recurrence VPS 54 心率骤降 开放试验 + (相对危险 降低85%) VASIS 42 DDI 开放试验 + 滞后功能 (5% vs 61%) SYDIT 93 心率骤降 起搏 vs + 阿替洛尔 (4.3% vs 25.5%) VPSII 100 心率骤降 双盲 – 研究 患者* 治疗 设计 结果** * ** VPS II Connolly: JAMA, 2003 累计风险 随机后月数 No. at risk 只感知不起搏 52 37 35 32 31 21 双腔起搏 48 37 35 34 34 18 Only sensing without pacing (ODO) Dual-chamber pacing (DDD) 血管迷走性晕厥治疗方案 倾斜试验阳性 保守 HR ￡60 盐,氟氢可的松甲氧胺福林 普萘洛尔 (其他b受体阻滞剂) 抗胆碱 BP 3110HR 370 BP 110 晕厥进展或不可耐受 永久起搏器 (CI) 联合/中枢 血管迷走性晕厥治疗方案 谢 谢 ！ CP1167250 Shen, WK JS 10-06-2004 CP1167250 Shen, WK JS 10-06-2004 CP1167250 Shen, WK JS 10-06-2004 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. CP1167250 Shen, WK JS 10-06-2004 CP1167250 Shen, WK JS 10-06-2004 Brignole M, Alboni P, Benditt D, et al. Guidelines on management (diagnosis and treatment) of syncope—Update 2004. Europace. 2004;6:467-537. CP1167250 Shen, WK JS 10-06-2004 This slide provides a simple classification of the principal causes of syncope, listed 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 terms ‘neurally-mediated syncope’, ‘neurally-mediated reflex syncope,’ and ‘neurocardiogenic syncope’ are generally used synonymously. For purposes of this presentation, ‘neurally-mediated syncope’ is used to define a broad category; ‘neurocardiogenic’ or ‘vasovagal sy