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Jingdong book

晕厥临床案例解析

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晕厥临床案例解析

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晕厥是引起一过性意识丧失最常见的原因之一。无论是什么原因引起的晕厥,它都是一种令人非常恐惧的经历,多数情况下,患者会立即寻求医疗评估。此时,患者及家属常常非常担忧,就诊的目的是想了解到底出了什么问题,能采取什么措施避免晕厥再次发生。他们尤其担心这些晕厥事件对其今后健康和社会活动的影响。但是,对于上述情况医生也没有充分的准备能做出最好的处理。尤其是诊断是否正确、是否对晕厥进行了充分的调查、给出的建议是否合适、建议是否与先进的治疗概念相一致、等等方面。
Catalogue

第一部分 神经介导性(反射性)晕厥
临床表现
病例1 儿童和青少年中的血管迷走性晕厥
病例2 典型的血管迷走性晕厥(恐惧血或外伤)
病例3 老年人的反射性晕厥
病例4 一过性意识丧失伴肌肉抽搐:晕厥还是癫痫?
病例5 倾斜试验诱发的晕厥:混合型反应
病例6 倾斜试验诱发的晕厥:心脏抑制型反应
病例7 倾斜试验诱发的晕厥:单纯血管抑制型反应
病例8 倾斜试验诱发的晕厥:自主神经异常反应
病例9 倾斜试验诱发的晕厥:变时功能不良
病例10 晕厥和直立位心动过速综合征
病例11 晕厥时的脑电图记录
病例12 倾斜试验中的心因性反应
病例13 神经介导性晕厥:表现为阵发性房室阻滞
病例14 延长的心电图监测记录到的心脏抑制机制引起的多种表现
病例15 神经介导性晕厥:误以为不明原因的跌倒
病例16 运动后血管迷走性晕厥
病例17 运动后神经介导性晕厥
病例18 血管迷走性晕厥干扰睡眠
病例19 妊娠期间发生的晕厥
病例20 有血管迷走性晕厥的飞行员是否适合飞行?
病例21 倾斜试验阴性、无器质性心脏病患者反复发作晕厥
病例22 吞咽晕厥伴心脏停搏
病例23 吞咽晕厥表现为房室传导阻滞
病例24 一过性舌咽反射性晕厥
病例25 咳嗽性晕厥
病例26 大笑引起的晕厥
病例27 晕厥与眼睛

治疗
病例28 对伴长时间心脏停搏的血管迷走性晕厥患者的长期随访
病例29 交叉腿和收缩肌肉预防血管迷走性晕厥
病例30 用绷紧手臂的动作避免血管迷走性晕厥
病例31 在持续的血压监测下训练患者生理性对抗性动作
病例32 倾斜训练治疗血管迷走性晕厥
病例33 恐血症引起的恶性血管迷走性晕厥的心理治疗
病例34 起搏治疗心脏抑制型神经介导性晕厥

颈动脉窦综合征
病例35 颈动脉窦综合征
病例36 仅在倾斜位发生的颈动脉窦过敏
病例37 复杂心脏抑制型神经介导性晕厥
病例38 继发于颈部肿瘤的颈动脉窦高敏综合征
病例39 颈动脉体神经节细胞瘤所致的晕厥
病例40 起搏器治疗的颈动脉窦综合征患者反复晕厥
病例41 老年患者不明原因的摔倒

第二部分 直立性低血压
病例42 致青少年晕厥的直立初始低血压
病例43 药物引起的60岁老年男性的直立初始低血压及晕厥
病例44 由蹲位起立所致的直立初始低血压
病例45 自身诱导性晕厥:昏倒游戏
病例46 自主神经功能衰竭患者自行诊断直立性低血压
病例47 58岁男性军团菌肺炎后不明原因一过性意识丧失
病例48 自主神经功能衰竭的患者减少直立性低血压的生理措施
病例49 交感神经切除术治疗多汗症引起的致残性直立性低血压
病例50 动脉压力反射衰竭所致的直立性低血压
病例51 高位脊髓损伤患者应激时出现低血压
病例52 嗜铬细胞瘤患者的直立性低血压与晕厥

第三部分 心律失常性晕厥
病例53 晕厥和Brugada综合征
病例54 Brugada综合征中2种类型的单形性室速是引起晕厥的原因
病例55 发热伴晕厥和Brugada样心电图表现:神经介导性还是心律失常性晕厥
病例56 获得性长QT综合征与晕厥
病例57 HIV感染患者接受美沙酮治疗时发生尖端扭转型室性心动过速而导致晕厥
病例58 先天性长QT间期综合征
病例59 运动揭示的长QT间期综合征
病例60 先天性长QT间期综合征:延长监测显示的尖端扭转型室性心动过速
病例61 短偶联间期引起的尖端扭转型室性心动过速
病例62 短QT间期患者的晕厥
病例63 无心脏病的女性晕厥,心电图正常,家族有猝死史
病例64 心悸和晕厥:一例罕见的心动过缓一心动过速综合征
病例65 儿童心律失常性晕厥:儿茶酚胺室性心动过速
病例66 三磷酸腺苷敏感的阵发性房室阻滞
病例67 腺苷依赖的晕厥
病例68 阵发性交界性心动过速引起的晕厥
病例69 房室结折返性心动过速患者发生的晕厥:反射性低血压?
病例70 年轻女性心律失常性和神经介导性晕厥
病例71 晕厥和Wolff-Parkinsorr-White综合征:房颤伴快速心室反泣
病例72 窦性心律下不明显预激的Wolff-Parkinson-White综合征:1:1房室传导的心房扑动
病例73 心房颤动患者的晕厥:反射性低血压?
病例74 神经性晕厥诱发心房颤动
病例75 特发性右室室速患者劳力情况下出现晕厥先兆
病例76 特发性左室室速引起的晕厥
病例77 晕厥和致心律失常性右心室发育不良
病例78 反复晕厥患者意外的电生理检查结果
病例79 右束支阻滞、交替性左前分支和左后分支阻滞患者的晕厥
病例80 束支阻滞患者发生血管迷走性晕厥
病例81 电生理检查提示存在间歇房室传导阻滞234.
病例82 束支阻滞,电生理检查结果阴性的晕厥
病例83 既往心肌梗死伴束支阻滞患者的晕厥
病例84 伴左束支阻滞的晕厥,置入双心室起搏除颤器

第四部分 晕厥和心血管疾病
病例85 表现为晕厥的急性冠状动脉综合征
病例86 晕厥作为冠状动脉左主干闭塞的孤立症状
病例87 心肌梗死患者的晕厥
病例88 急性心肌梗死和完全性心脏阻滞:早期再血管化介入治疗
病例89 慢性缺血性心脏病的晕厥:电生理检查中诱发室速
病例90 既往心肌梗死患者的晕厥:电生理检查中诱发的室颤
病例91 扩张型心肌病患者的晕厥,电生理检查阴性,左心室功能减退
病例92 肥厚型梗阻性心肌病伴左束支阻滞发作晕厥
病例93 肥厚型心肌病患者心房扑动伴1:1房室传导
病例94 肥厚型心肌病合并房颤伴快速心室反应晕厥
病例95 伴有心尖部室壁瘤的室间隔中部肥厚型心肌病患者发生致晕厥的室性心动过速
病例96 类癌综合征
病例97 肌强直I生营养不良与晕厥
病例98 Kearns-Sayre综合征与晕厥
病例99 主动脉瓣狭窄所致晕厥
病例100 主动脉瓣置换术后的晕厥
病例101 人工主动脉瓣和宽QRS心动过速患者的晕厥
病例102 左房黏液瘤引起的晕厥先兆
病例103 左心房血栓所致的晕厥
病例104 表现为晕厥的心包填塞
病例105 急性主动脉夹层所致的晕厥
病例106 表现为晕厥的肺动脉栓塞
病例107 锁骨下窃血综合征引起的晕厥
病例108 多种恶性病因导致的年轻女性晕厥
索引
Book Abstract

病例报告
一名23岁女性患者,由于反复晕厥发作被送至晕厥门诊。既往无心脏疾病史、无晕厥和猝死家族史。她的晕厥史始于4年前,在近9个月间有5次晕厥发作。所有晕厥均在站立情况下发生,没有明确的诱发因素,发作前有短暂的前驱症状。患者从没有癫痫发作或尿失禁。在一次发作中曾发生轻微的颅脑损伤。
体格检查正常,未闻及心脏杂音。基础动脉血压正常,当变为直立体位时血压没有异常改变。基础心电图示窦性心律,70次/分,正常的PR和QT间期,QRS波形态正常。
由于反复发作,无器质性心脏病证据,晕厥发作中有外伤发生及晕厥发作相对突然的特点,因此本病例有进行倾斜试验的指征。
倾斜试验计划在不给予药物情况下,60°角倾斜,持续20分钟,随后给予400g硝酸甘油舌下含服。连续监测心电图,应用Finapres系统进行无创动脉血压监测,所有信号使用LabSystem进行记录和显示。在倾斜试验开始后,患者心率明显增快,5分钟后在没有给予药物的情况下,患者主述短暂的前驱症状后随即意识突发丧失。此刻心电监护显示,窦性心动过速伴进行性低血压,随之出现动脉血压的急剧下降(图7.1)。然后患者被置于Tren-delenburg体位,可观察到心率轻微的下降。此后意识和动脉血压快速恢复。
由于非常突然的血管抑制及为了除外潜在的测量误差,一周后进行了第二次倾斜试验。在最初几分钟及未用药时期,患者在短暂的前驱症状后出现突发意识丧失,随后有抽动,同时伴动脉血压急速下降及心率的轻度下降(图7.2)。
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根据倾斜试验中低血压和心动过缓的程度和持续时间对倾斜试验阻性反应进行了分型。新近对分型进行了修改,建议不仅要考虑晕厥期间心率和动脉血压情况,还要考虑晕厥的前驱情况。最常观察到的反应是混合型反应(1型),其次是心脏抑制型反应,多为2a型。已有报道,单纯血管抑制型反应通常与晕厥前期自主神经反应异常有关,包括倾斜后很快出现舒张压进行性下降。
Introduction

晕厥是引起一过性意识丧失最常见的原因之一。无论是什么原因引起的晕厥,它都是一种令人非常恐惧的经历,多数情况下,患者会立即寻求医疗评估。此时,患者及家属常常非常担忧,就诊的目的是想了解到底出了什么问题,能采取什么措施避免晕厥再次发生。他们尤其担心这些晕厥事件对其今后健康和社会活动的影响。但是,对于上述情况医生也没有充分的准备能做出最好的处理。尤其是诊断是否正确、是否对晕厥进行了充分的调查、给出的建议是否合适、建议是否与先进的治疗概念相一致、等等方面。
在引起一过性意识丧失的众多情况中,晕厥是指短暂的、自限性的,因大脑灌注不足引起的一过性的意识丧失(多数是由于一过性的血压下降)。正是上述特殊的病理生理学特点使得晕厥区别于其他引起全脑功能异常的病因,如:
癫痫:一过性意识丧失是由于原发的大脑电异常
脑震荡:一过性意识丧失是由于颅脑外伤所致
中毒:毒物引起可逆性意识障碍
精神性假性晕厥(以前错误地命名为“精神性晕厥”):是由于精神原因造成的表现,而不是真正发生了一过性意识丧失。
鉴于晕厥发生的频率(估计占急诊室就诊的1%~3%),对临床的潜在意义(如身体伤害、驾驶限制、丧失职业、早期丧失独立生活能力)等情况,对于疑诊晕厥患者如何制定合理的诊疗策略看来是非常关键的。考虑到上述需要,近年来的关注点都指向寻找最有效的诊断技术和诊疗方案方面(欧洲心脏病学会晕厥临床指南于2001年公布,2004年进行了更新)。
本书由来自4个国家的7名晕厥治疗领域的著名作者主编,还有其他130名作者参与编写。提供了不同病因引发晕厥的病例,有助于更好地理解晕厥,以便为晕厥患者提供更准确、费效比更好的医疗。
与以往的多数传统的教科书和指南不同,本书作者采用了一种生动的、简单易读的病例的形式来进行讲解。这种形式是医务工作者较为熟悉和更容易接受的形式。事实上,读者读到的是一个个真实的临床病例,每个病例均有简要的临床描述。几乎提供了各种原因引起的晕厥的病例,包括不同形式的中枢介导的反射性晕厥,以及常见的和不常见的与真正晕厥或看似真正晕厥相关的临床情况。

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Yami has a consolidation warehouse in China which collects multiple sellers’ packages and combines to one order. Our Yami consolidation warehouse will directly ship the packages to your door. Cross-store free shipping over $69.

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You may return products within 30 days upon receiving the products. Sellers take responsibilities for any wrong shipment or missing items. Packing needs to be unopened for any other than quality issues return. We promise to pack carefully, but because goods are taking long journey to destinations, simple damages to packaging may occur. Any damages not causing internal goods quality problems are not allowed to return. If you open the package and any quality problem is found, please contact customer service within three days after receipt of goods.

Shipping Information

Yami Consolidation Service Shipping Fee $9.99(Free shipping over $69)

Sellers in China will ship their orders within 1-2 business days once the order is placed. Packages are sent to our consolidation warehouse in China and combined there. Our Yami consolidation warehouse will directly ship the packages to you via UPS. The average time for UPS to ship from China to the United States is about 10 working days and it can be traced using the tracking number. Due to the pandemic, the delivery time may be delayed by about 5 days. The package needs to be signed by the guest. If the receipt is not signed, the customer shall bear the risk of loss of the package.

Sold by JD@CHINA

Service Guarantee

Free shipping over 69
Genuine guarantee

Shipping

Yami Consolidated Shipping $9.99(Free shipping over $69)


Seller will ship the orders within 1-2 business days. The logistics time limit is expected to be 7-15 working days. In case of customs clearance, the delivery time will be extended by 3-7 days. The final receipt date is subject to the information of the postal company.

Yami Points information

All items are excluding from any promotion or points events on Yamibuy.com

Return Policy

You may return product within 30 days upon receiving the product. Items returned must be new in it's original packing, including the original invoice for the purchase. Customer return product at their own expense.

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About the brand

Jingdong book

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About the brand

Jingdong book