2026 年第 9 期 第 21 卷

情境性晕厥的多因素分析

Multivariate analysis of situational syncope

作者：徐新娜1王佳玉2吴越阳3张佳2魏欣2刘巍1

英文作者：Xu Xinna1 Wang Jiayu2 Wu Yueyang3 Zhang Jia2 Wei Xin2 Liu Wei1

单位：1首都医科大学附属北京积水潭医院心内科，北京100035；2首都医科大学附属北京天坛医院神经心脏病科，北京100070；3首都医科大学附属北京天坛医院心血管内科，北京100070

英文单位：1Department of Cardiology Beijing Jishuitan Hospital Capital Medical University Beijing 100035 China; 2Department of Neurocardiology Beijing Tiantan Hospital Capital Medical University Beijing 100070 China; 3Department of Cardiovascular Medicine Beijing Tiantan Hospital Capital Medical University Beijing 100070 China

关键词：情境性晕厥；迷走神经性晕厥；直立倾斜试验；对比增强经颅多普勒超声

英文关键词：Situationalsyncope;Vasovagalsyncope;Head-uptilttest;Contrast-enhancedtranscranialDoppler

• 摘要：

• 目的 探讨情境性晕厥（SS）患者的临床特征及相关因素。方法 回顾性选取2021年1月至2024年6月于首都医科大学附属北京天坛医院和首都医科大学附属北京积水潭医院被诊断为SS的患者625例作为研究对象。所有患者均接受直立倾斜试验（HUTT）和对比增强经颅多普勒超声（cTCD）检查。总结SS患者的一般临床数据特征、HUTT及cTCD评估的右向左分流（RLS）严重程度，并进一步评估HUTT及RLS的相关因素。结果 SS患者年龄（48±10）岁、男性352例、体重指数（24.2±2.7）kg/m2、晕厥次数（3.5±2.5）次、晕厥前期247例、吸烟202例、高血压病123例、糖尿病48例、血脂异常59例、冠状动脉疾病25例、应用α受体阻滞剂15例、应用β受体阻滞剂21例、应用钙通道阻滞剂19例、应用血管紧张素转换酶抑制剂20例、应用血管紧张素Ⅱ受体拮抗剂43例、应用利尿剂21例。SS患者中HUTT阳性共528例，其中基础被动直立倾斜阶段（b-HUTT）共36例、舌下硝酸甘油阶段（SN-HUTT）共492例，b-HUTT持续时间（15.5±2.1）min、SN-HUTT持续时间（4.5±2.2）min。SS患者中cTCD阳性429例，其中大量分流164例、中量分流117例、轻量分流148例。多因素回归分析结果显示男性、体重指数（超重和肥胖）、吸烟状况、HUTT阳性反应和大量分流均是SS的相关因素(均P<0.05)。结论 SS的发生与性别、体重指数、吸烟史、HUTT阳性反应、cTCD分流严重程度相关。

• Objective To investigate the clinical characteristics and associated factors in patients with situational syncope (SS). Methods A total of 625 patients diagnosed with SS in Beijing Tiantan Hospital, Capital Medical University and Beijing Jishuitan Hospital, Capital Medical University from January 2021 to June 2024 were retrospectively enrolled as research subjects. All patients underwent head-up tilt test (HUTT) and contrast-enhanced transcranial Doppler (cTCD) examination. General clinical characteristics of SS patients and the severity of right-to-left shunt (RLS) assessed by HUTT and cTCD were summarized, and the factors correlated with HUTT results and RLS were further evaluated. Results The age of SS patients was (48±10) years old, including 352 males; body mass index (BMI) was (24.2±2.7)kg/m2; the number of syncope episodes was (3.5±2.5); 247 patients presented presyncope, 202 had smoking history, 123 suffered from hypertension, 48 had diabetes mellitus, 59 had dyslipidemia, and 25 had coronary artery disease. Fifteen patients received α-receptor blockers, 21 received β-blockers, 19 received calcium channel blockers, 20 received angiotensin-converting enzyme inhibitors, 43 received angiotensin Ⅱ receptor antagonists, and 21 received diuretics. Among SS patients, 528 had positive HUTT results, including 36 cases positive at baseline head-up tilt test (b-HUTT) stage and 492 cases positive at sublingual nitroglycerin head-up tilt test (SN-HUTT) stage. The duration of b-HUTT was (15.5±2.1) min, and the duration of SN-HUTT was (4.5±2.2) min. Four hundred and twenty-nine patients showed positive cTCD results, including 164 with large shunt, 117 with moderate shunt and 148 with mild shunt. Multivariate regression analysis revealed that male gender, overweight and obese BMI, smoking status, positive HUTT response and large shunt were associated factors of SS (all P<0.05). Conclusion The occurrence of SS is correlated with gender, body mass index, smoking history, positive HUTT response and the severity of shunt detected by cTCD.