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目的探讨无晕厥病史患者出现的直立性T波改变的发生机理及其与血管迷走性晕厥的相关性;方法利用活动平板运动试验初筛出直立性T波改变预检患者,经基础倾斜试验进一步确证,再行硝酸甘油倾斜试验。第2天,阳性患者经随机分组,双盲对照服用安慰剂(=22)或30mg普荼各尔(=21)60min后重复基础倾斜试验、硝酸甘油倾斜试验。结果100例直立性T波改变患者在基础倾斜试验中无1例阳性反应,在随后的NTTT中有43例出现阳性结果。第2天,安慰剂组直立性T波改变及NTTT阳性有比率明显高于普荼各尔组(依次为86.4%∶23.8%,P<0.01,72.7%∶28.6%,P<0.01)。结论直立性T波改变是人体由卧位到立位引起神经-体液变化所致的心室肌复极异常,它是血管迷走性晕厥形成过程中某一阶段出现的一种伴随现象,与血管迷走性晕厥有一定的相关性,心得安等β-受体阻滞剂作为首选药物来治疗直立性T波改变和伴随有直立性T波改变的血管迷走性晕厥患者,收到肯定的临床疗效。
Objective To investigate the pathogenesis of orthostatic T-wave changes in patients without history of syncope and its relationship with vasovagal syncope. Methods The patients with pre-test of elevation T-wave changes were screened by active treadmill exercise test. Confirmation, then nitroglycerin tilt test. On day 2, positive patients were randomized to repeat the basal tilt test and the nitroglycerin tilt test on a double-blind, placebo-controlled (= 22) or 30 mg (= 21), 60 min arm. Results None of the 100 patients with echocardiographic T wave changes had a positive response to the basal tilt test, with a positive result in 43 of the subsequent NTTTs. The ratio of upright T wave changes and NTTT positive in placebo group was significantly higher than that in the Putu group on the second day (86.4%, 23.8%, P <0.01, 72.7%, 28.6%, P <0.01). Conclusions The change of erection T wave is the ventricular repolarization induced by neuro - humoral changes from lying position to standing position. It is a concomitant phenomenon at some stage in the process of vasovagal syncope. Sexual syncope has some relevance, such as security, β-blockers as the drug of choice for the treatment of orthostatic T wave changes and accompanied by erect T wave changes in patients with vasovagal syncope, received a positive clinical effect.