晕厥(晕倒)
晕厥也被称为昏厥或“昏倒”."
它最常发生在 血压太低了 (a condition called hypotension) and the heart doesn't pump enough oxygen to the brain. 它可能是无害的，也可能是潜在疾病的症状.
晕厥的原因?
晕厥是一种有多种原因的症状, 从无害到危及生命不等. 许多不危及生命的因素, 比如强烈的情绪, 大量出汗, exhaustion or the pooling of blood in the legs due to sudden changes in body position, 会引发晕厥. It's important to determine the cause of syncope 和一个y underlying conditions.
然而，一些严重的心脏病，比如 心动过缓, 心动过速 或血流受阻，也可引起晕厥.
什么是神经介导性晕厥?
Neurally mediated syncope (NMS) is the most common form of fainting and a frequent reason for emergency department visits. It's also called reflex, neurocardiogenic, vasovagal (VVS) or vasodepressor syncope. 它是无害的，很少需要治疗.
NMS is more common in children and young adults, though it can occur at any age. It happens when the part of the nervous system that regulates blood pressure and heart rate malfunctions in response to a trigger, 比如情绪压力或疼痛.
NMS通常发生在长沙巴足球体育平台站立后. 它通常伴随着一种温暖的感觉, 恶心想吐, 头晕, 隧道视觉或视觉“灰色”." Placing the person in a reclining position restores blood flow and consciousness.
情境性晕厥, 哪一种是NMS, 与某些身体机能有关吗, 比如剧烈咳嗽(尤其是男性), 笑, 吞咽或排尿.
其他疾病也会引起晕厥. 它也可能由某些药物引起.
有些类型的晕厥表明严重的疾病是:
- 在运动或努力时发生的.
- 心悸的与心悸或心脏不规则有关的
- Associated with family history of recurrent syncope, heart disease at a young age or sudden death
什么是心源性晕厥?
Cardiac (cardiovascular) syncope is caused by various heart conditions, 比如心动过缓, 心动过速或某些类型的低血压. 它可以表明患病风险的增加 心源性猝死.
People suspected of having cardiac syncope but who don't have serious medical conditions may be managed as outpatients. Further in-patient evaluation is needed if serious medical conditions are present. Conditions that may warrant hospital evaluation and treatment include various abnormal heart rhythms, 冠状动脉疾病, 严重的主动脉狭窄和肺栓塞. 如果评估提示心脏血管异常, or if you have experienced multiple instances of fainting due to heart problems, 可能需要一个动态外部或植入式心脏监护仪.
病窦综合征, 心房纤颤 and other serious cardiac conditions can cause recurrent syncope in older adults, 70岁以后会急剧增加.
风险因素是什么?
Syncope is common, and older adults are at greater risk of hospitalization and death.
Younger people without cardiac disease but who've experienced syncope while standing or have specific stress or situational triggers aren't as likely to experience cardiac syncope.
心脏性晕厥在男性和60岁以上人群中风险更高. 具有以下特征的人也有更高的风险:
- 已知的缺血性心脏病, 结构性心脏病, 以前的心律失常, 或者心室功能降低
- 短暂的心悸或突然失去意识
- 运动时晕厥
- 昏倒的:平躺在地上昏倒的
- 昏厥发作次数少(1或2次)
- 心脏检查异常
- Family history of inheritable conditions or premature 心源性猝死 (<50 years of age)
- 已知有先天性心脏病
初步评估
任何晕厥患者都应该接受初步评估, including detailed physical exam and medical history and measurement of blood pressure and heart rate, 医生.
静止的12领先 心电图 (electrocardiogram) also is recommended as part of an initial evaluation to provide information about the cause of syncope. 心电图 is widely available and inexpensive and can provide information about the potential and specific cause of syncope, 比如心律失常. 其他测试，如 运动压力测试, 动态心电监测 和一个 超声心动图，可能需要评估其他心脏原因.
An 心电图 also is recommended for children and young adults with syncope. Other noninvasive diagnostic testing may be needed if they're suspected of having 先天性心脏病, 心肌病 或者一个 心律失常.
If the initial evaluation is unclear, it may be useful for patients to undergo a tilt test. The blood pressure and heart rate will be measured while lying on a board and with the board tilted up. VVS患者, 或者反射性昏厥, 通常会在倾斜期间晕倒, 由于血压和心率的快速下降. When people are placed on their back again, blood flow to the brain and consciousness are restored.
Patients with VVS and without a serious medical condition usually can be managed in an outpatient setting. For older adults, a comprehensive approach in collaboration with a geriatric expert can be helpful.
适合脱水的人, it may be beneficial to increase their salt and fluid intake to prevent syncope. That recommendation – as well as the removal or reduction of hypotensive drugs and diuretics – also may be encouraged when appropriate and safe for people who've experienced syncope as an adverse drug reaction.
摄入更多的盐和液体对大多数儿科患者有益, 但VVS患者的结果尚不清楚. 其他生活方式的改变, 如一旦心源性晕厥就排除了运动, 也可以使儿科患者受益.
Patients of any age may need medication to help control or improve syncope.
当晕厥发作后开车, there are no restrictions for VVS patients who had no fainting spells in the previous year. But it may be helpful for health care professionals to discuss regional driving laws, 对所有患者的限制和影响.
A cardiovascular assessment by a health care professional is recommended f或者一个thletes before resuming competitive sports. Those with syncope and a structural 心律失常 should also see a specialist. Extended monitoring may help athletes with unexplained exertional syncope.
晕厥的未来
Standardized national registries and large databases are needed to gather more data to better understand the incidence and prevalence of syncope, 患者风险和结果, 制定生活方式政策，改善卫生保健服务.
一些研究表明，随着昏厥的反复发作, the quality of life is reduced in both adults and in pediatric patients. 然而, 更多精心设计的研究纳入了生活质量, work loss and functional capacity are needed to better understand the relationship of syncope symptoms, 导致各种结果的原因和潜在疾病.
