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| 題 名 | Mechanisms of Cough Syncope as Evaluated by Valsalva Maneuver=利用Valsalva Maneuver來研究咳嗽昏厥之致病機轉 |
|---|---|
| 作 者 | 趙雅琴; 林瑞泰; 劉景寬; 王寶玉; 許弘毅; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
| 卷 期 | 23:2 2007.02[民96.02] |
| 頁 次 | 頁55-62 |
| 分類號 | 415.932 |
| 關鍵詞 | 咳嗽昏厥; 低血壓; 胸內壓; Cough syncope; Hypotension; Intrathoracic pressure; Valsalva maneuver; |
| 語 文 | 英文(English) |
| 中文摘要 | 欲成功地治療「咳嗽昏厥」則必先了解及處理該類病人之不同的致病機轉。Valsalva maneuver 所引起的血流動力學改變,基本上極似咳嗽所引起的變化,因此也可用作研究咳嗽昏厥致病機轉的方法。本研究納入因咳嗽而昏厥之病患,共 18 位進入研究,在以穿顱超音波及非侵入性紅外線手指血壓計 (servo-controlled infrared finger plethysmography) 連續監控紀錄血壓及腦血流之下,要求患者作 valsalva maneuver 及咳嗽數次,結果 8 位患者在鬆開壓力時並沒有正常所見之血壓回衝 (overshoot) 現象。這些病人在要求作咳嗽時,其血壓下降後回復期與 valsalva maneuver 正常者相較也有意義的延長 (median, 16.4; range, 8.7–25.6 秒比 median, 2.6; range, 1.3–3.8 秒,p < 0.001)。在 valsalva maneuver 正常者 10 人中有 7 人有腦血管或心血管狹窄,在 valsalva maneuver 異常者 8 人 (即血壓無回衝者),只有 1 人有腦血管或心血管狹窄 (70% vs. 12.5%,p = 0.025)。其餘如臨床表徵,body mass index,阻塞性肺病之機率和 valsalva ratio 則在二組病人中無有差異。總結,患者在 valsalva maneuver 時無有血壓回衝者,也同時呈現咳嗽後血壓下降延遲恢復之現象。因此 valsalva maneuver 可以幫助區分咳嗽昏厥之病理機轉,進而可以成為一研究及治療患者之方法。 |
| 英文摘要 | Successful treatment of cough syncope depends on the correction of various pathogenetic mechanisms among different patients. The valsalva maneuver (VM), which elicits hemodynamic responses mimicking coughs, has potential for investigating the individual pathogenesis of cough syncope. Eighteen consecutive patients suffering from cough-induced syncope were examined. All patients were asked to cough and to perform VM several times under continuous cerebral blood-flow velocity and blood pressure (BP) monitoring by transcranial Doppler and finger plethysmography. Eight patients demonstrated abnormal VM characterized by the absent BP overshoot following the relief of straining. Patients demonstrating abnormal VM had delayed BP recovery after cough (median, 16.4; range, 8.7–25.6 seconds) compared to those demonstrating normal VM (2.6, 1.3–3.8 seconds, p < 0.001). Seven of the 10 patients exhibiting normal BP overshoot during VM had stenotic arterial lesions in the cerebral or coronary circulation, whereas only one of the eight patients demonstrating absent BP overshoot had coronary artery disease (70% vs. 12.5%, p = 0.025). Other clinical profiles, body mass index, frequency of obstructive pulmonary disease and valsalva ratio did not differ between patients featuring normal and absent BP overshoot. In conclusion, the pathogenesis of cough syncope could be different between patients with normal and abnormal VM responses. Patients who had no BP overshoot during VM sustained prolonged hypotension after cough. The VM helps in discriminating among pathogenic mechanisms and guiding investigation and treatment for cough syncope patients. |
本系統中英文摘要資訊取自各篇刊載內容。