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晕厥的诊治无锡二院老年科黄伟SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.主要内容1.晕厥的定义及流行病学2.晕厥的分类3.晕厥的分期4.晕厥的诊断5.晕厥的治疗6.案例分析SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.晕厥(syncope)晕厥(syncope)是全脑组织血液供应突然减少，引起网状结构上行激活系统抑制，导致发作性短暂意识丧失伴姿势性肌张力丧失床综合征。特点：1.短暂的2.自限性3.临床综合症4.短暂的意识丧失（T-LOC）的一种SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.短暂的意识丧失（TLOC)包括所有形式的短暂的、自发终止的意识丧失晕厥癫痫发作脑震荡摔倒意识改变是否是一过性？突然发生？短暂？自限性？昏迷SCD幸存其他T-LOC非创伤创伤晕厥癫痫抽搐心理性少见原因意识丧失SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.晕厥的流行病学占全部住院病人的1-6%占急诊病人的3％30%反复发作TheRiskstratificationOfSyncopeintheEmergencydepartment(ROSE)pilotstudy:acomparisonofexistingsyncopeguidelines.ReedMJ1etal.,EmergMedJ.2007Apr;24(4):270-5.SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.0.730.710.60.370%20%40%60%80%100%不安/忧虑严重影响日常生活限制驾驶影响就业Recurrentsyncopeasachronicdisease:preliminaryvalidationofadisease-specificmeasureoffunctionalimpairment.LinzerMetal.JGenInternMed.(1994)晕厥的流行病学SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.晕厥的临床表现典型的晕厥发作可分为3期。(1)前驱期：自主神经症状明显，突然面色苍白，出冷汗，恶心，上腹不适，瞳孔扩大，疲乏，头晕，耳鸣，打哈欠和视物模糊等，因肌张力减低而身体摇摆。此期经时数秒，如此时患者立即坐下或躺下，则症状逐渐消退，否则很快意识丧失而进入下一期。(2)晕厥期：意识丧失及全身肌张力消失而倒下。患者脉搏细微，血压常降低，呼吸变浅，瞳孔散大及对光反射消失，腱反射消失，肢端冷，可有尿失禁，此期经时数秒至几分钟，意识逐渐恢复而进入下一期。如意识丧失时间长达数十秒，可发生小的面部及肢体肌阵挛性抽动。(3)恢复期：患者逐渐清醒，仍面色苍白，出汗，全身软弱。可有恶心，过度换气，但无意识模糊及头痛。休息数十分钟可完全恢复。如刚清醒就很快立起，可再次晕倒。发病后不会留下神经及躯体的后遗症。有的发作可无前驱不适，一发病就意识丧失而跌倒，容易造成外伤。前驱期脑电图见脑波频率减慢及波幅增高；晕厥期为普遍2～3Hz慢活动；恢复期脑波逐渐转为正常。SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.晕厥的评估流程晕厥病史、体格检查、立卧位血压、基础心电图肯定或怀疑诊断评估/确定疾病诊断成立治疗不能解释晕厥器质性心脏病或心电图异常没有器质性心脏病或心电图正常心脏评估+—治疗经常发生或严重一次或很少发生评估不作进一步评估+—治疗再评估NoSetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.晕厥的评估:实验室检查“常规检查”•血常规,电解质,血糖•心电图“可选择的检查”•超声心动图•动态心电图•动态血压监测•动态事件记录器•植入式事件记录器•倾斜试验•电生理检查•神经系统检查–自主神经功能检查,脑电图,眼动脉血流描记,颈动脉超声,经颅多普勒,CT,MRI•内分泌检查–血清儿茶酚胺,尿甲氧基肾上腺素•其他心脏检查–运动试验,冠脉造影•三磷酸腺苷实验在详细询问病史、体格检查（包括测量不同体位血压）以及心电图检查基础上，可以适当增加其他的检查以保证诊断准确SetupsafetyproductionleadinggroupandprovidePartyAwithcopiesofjobcertificate,operationcertificateandIDcardoftheresponsiblepersononsite,safetyresponsiblepersonandallemployees.PartyBshallberesponsibleforthepersonalsafety,constructionequipment,livingfacilities,mechanicalandelectricalequipmentandconstructionsafetyofPartyB.晕厥的常规检查——心电图标准12导心电图；动态