“醫(yī)學英語雙語閱讀：暈厥”相信是準備學習醫(yī)學英語的朋友比較關注的事情，為此，正保醫(yī)學教育網小編整理內容如下：
| Syncope | 暈厥 |
| James C. Chesnutt | |
| Syncope is a common and concerning medical problem, which accounts for 3% of emergency room visits and up to 6% of hospital admissions. Although the cause of syncope can be life-threatening （e.g., ventricular tachycardia） and the result can be devastating （e.g., fractured hip）, a definitive explanation for syncope is found less than one half of the time. Syncope recurrence is approximately 20% per year compared with an incidence of 2% for an initial episode of syncope. | 暈厥是一種令人擔憂的常見病，占急診病例的3%，住院病例中可達6%。雖然暈厥的病因可能危及生命（如室性心動過速），并會產生嚴重后果（如髖部骨折），但說得清楚的暈厥卻不到一半。暈厥的復發(fā)率大約為20%年，初發(fā)率則為2%?！?/td> |
| I. Approach.Syncope is a brief loss of consciousness with collapse resulting from transient brain dysfunction based on decreased blood flow or neurologic insult. Syncope can be categorized based on the causative mechanism （See Table below）. The most common causes are vasovagal （18%）, arrhythmia （14%）, neurologic （10%）, orthostatic hypotension （8%）, and situational （5%）. | I. 診斷思路暈厥是暫時性意識喪失并跌倒，它是因為血流減少或神經損傷而造成一過性大腦功能失調而引起的。根據誘發(fā)機制，暈厥可以分為幾類。從誘因看，最常見的有血管迷走神經性（占18%）、心率不齊性（14%）、神經性（10%）、直立性低血壓性（8%）和環(huán)境因素引起的暈厥（5%）?！?/td> |
Table: Types of syncope with selected examples CARDIOGENIC SYNCOPE （CS）1. Arrhythmia, including ventricular tachycardia, sick sinus syndrome, atrial fibrillation, atrioventricular block and others （See Chapters 7.3, 7.9, and 7.12）2. Organic heart disease, including coronary artery disease congestive heart failure valvular disease, hypertrophic cardiomyopathy, and others.NEUROGENIC SYNCOPE （NS）1. Seizure disorder2. Transient ischemic attack and stroke3. Subclavian steal syndrome and othersNEUROCARDIOGENIC SYNCOME （NCS）1. Vasovagal2. carotid sinus hypersensitivity3. Orthostatic hypotension4. Dysautonomic5. Postural orthostatic tachycardia syndrome6. Situational, including micturition, cough, and othersUNCLASSIFIED SYNCOPE1. Drugs2. Alcohol3. Psychogenic4. Hypoglycemia5. Pregnancy6. Hypoxemia, dehydration, and others | 心源性暈厥（CS）1. 心律失常，包括室性心動過速、病竇綜合癥、房性纖顫、房室傳導阻滯，其他。2. 器質性心臟病，包括冠狀動脈疾病、充血性心力衰竭、心臟瓣膜疾病、肥厚性心肌病，其他。神經性暈厥（NS）1. 癲癇。2. 一過性腦缺血發(fā)作和腦卒中。3. 鎖骨下動脈竊血綜合征及其他。神經心源性暈厥（NCS）1. 血管迷走神經性。2. 頸動脈竇過敏。3. 直立性低血壓。4. 自主神經功能紊亂。5. 體位性心動過速綜合癥。6. 環(huán)境因素，包括排尿、咳嗽，其他。未分類暈厥1. 藥物。2. 酒精。3. 心理因素。4. 低血糖。5. 妊娠。6. 低氧血癥，脫水及其他?！ ?/td> |
| II. History | II. 病史檢查 |
| A. What are the symptoms or circumstances related to the syncope?1. Dizziness preceding syncope is highly associated with a psychological cause （24%） versus syncope without preceding dizziness （5%）. Dizziness with syncope can also be associated with arrhythmia. 2. Important history includes palpitation, duration of prodrome and recovery, and presence of postural or exertional symptoms. 3. Related environmental factors include heat, dehydration, and alcohol. | A. 暈厥相關癥狀或情況1. 與無頭暈性暈厥相比，頭暈后暈厥與精神性誘因關聯(lián)很大，前者占5%，后者則占24%。頭暈伴暈厥也與心律不齊有關。 2. 重要病史包括：心悸、前驅癥狀及恢復時間、以及體位性或勞力性癥狀。 3. 相關環(huán)境因素包括：高溫、脫水和酒精?！?/td> |
| B. Which disease, risk factor, or family history is present? | B. 疾病、危險因素及家族史 |
| 1. Organic heart disease is associated with arrhythmia and increased risk of death. 2. Psychiatric illnesses most commonly associated with syncope are major depression （12.2%）, alcoholism （9.2%）, generalized anxiety disorder （8.6%）, and panic disorder （4.3%）. These correlate with a higher rate of recurrent syncope, younger age, and a more benign course. | 1. 器質性心臟病可伴隨心律不齊和死亡危險增加。 2. 與暈厥最有關系的精神疾病包括嚴重的抑郁（12.2%）、酒精中毒（9.2%）、全身性焦慮（8.6%）和恐懼?。?.3%）。上述疾病通常與較高的暈厥復發(fā)率、年幼和較為良性的病程有關?！?/td> |
| 3. Older age （>60 years） is more highly associated with arrhythmias, orthostatic hypotension, medication side-effects, and situational （e.g., micturition） syncope. 4. Ask about diabetes mellitus, neuropathy, anemia, and other chronic diseases. 5. Inquire about a family history of sudden death, hypertrophic cardiomyopathy, or other organic heart disease. | 3.3. 老齡病人（＞60歲） 與心律不齊、直立性 低血壓、藥物副作用 和環(huán)境性（如排尿） 暈厥關聯(lián)更大。 4. 詢問糖尿病、神經 病、貧血和其他慢性 病。 5. 查詢卒死、肥厚性心 肌病及其他器質性心 臟病的家族史?！?/td> |
| C. What medications does the patient take? | C. 病人用藥 |
| The most commonly implicated are antihypertensives and antidepressants. Others include antianginals, analgesics, and sedatives. | 最常見的影響藥物有降壓藥和抗抑郁劑。其他藥物包括抗心絞痛藥、麻醉劑和鎮(zhèn)靜劑?！?/td> |
| III. Physical Examination | III. 體格檢查 |
| A. A. General: mental status, temperature, hydration status, pallor, or cyanosis. B. Vital signs: tachycardia, bradycardia, irregularity, or orthostatic hypotension. C. Cardiovascular: heart sounds, murmurs, bruits, edema, rales, and pulses. D. Neurologic: cranial nerves, reflexes, strength and sensation, tremor, Romberg's sign, gait, and cerebellar signs | A. 一般檢查：心理狀態(tài)、體溫、水合狀況、蒼白和發(fā)紺。 B. 生命體征：心動過速、心博徐緩、不規(guī)則及直立性低血壓。 C. 心血管：心音、雜音、嘈聲、水腫、羅音、脈博。 D. 神經性：顱內神經、反射、力度和感覺、震顫、Romberg’s體征、步態(tài)和腦部體征?！?/td> |
| IV. Testing | IV. 實驗室檢查 |
| A. Electrocardiogram （ECG） | A. 心電圖（ECG） |
| The most important single initial test to evaluate syncope is the ECG; it is easy and inexpensive and can quickly identify life-threatening arrhythmias or ischemia. Although the diagnostic yield is only 5%, if the ECG is normal, ischemia, arrhythmias, and organic heart disease are very unlikely. If the ECG is abnormal but does not clearly demonstrate a likely cause for syncope （complete heart block or runs of ventricular tachycardia, for example）, other tests are needed to clarify the underlying problem that may be related to the syncope. The result of the ECG, therefore, helps to direct the course of further workup. | 開始檢查暈厥時最重要的單項初始實驗室檢查是ECG。這種方法簡便價廉、可迅速識別對生命有威脅的心律不齊或局部缺血。雖然陽性診斷率僅5%，只要ECG正常，也基本能排除心肌局部缺血、心率不齊和器質性心臟病。如果ECG檢查異常，但無法清楚地驗證暈厥的潛在原因（如完全性傳導阻滯或室性心動過速），就需要進行其他檢查，以澄清與暈厥相關的潛在疾病。因此，ECG結果有助于指導進一步的檢查?！?/td> |
| B. Cardiac monitors | B. 心臟監(jiān)測 |
| 1. Holter monitor or telemetry performed for 24 hours. For patient with organic heart disease, this gives a diagnostic yield of from 2% for arrhythmias correlated to symptoms to 21% with unrelated arrhythmias. Extending this monitoring to 72 hours is not useful. 2. A loop event monitor is a portable, prolonged ambulatory event recorder indicating if there is recurrent syncope and no organic heart disease （yield = 24% to 47%）. | 1. 進行24小時動態(tài)心電監(jiān)測或遠程監(jiān)測。對器質性心臟病患者，這種檢查能診斷2%的有癥狀心律失常和21%的無癥狀心律失常。將監(jiān)測時間延長至72小時并無意義。 2. 記憶環(huán)心血管事件監(jiān)測器是一種便攜式、可長時間記錄病人活動時心血管事件的裝置，可以表明是否有復發(fā)性暈厥與器質性心臟?。ㄔ\斷率為24%至47%）。 |
| C. Electrophysiologic studies. | C. 電生理檢查 |
| This invasive cardiac monitoring and arrhythmia induction procedure gives a 50% diagnostic yield for those with organic heart disease or abnormal ECG （compared with 10% if no organic heart disease）. This is considered the gold standard for arrhythmia diagnosis but it is expensive and invasive. Powerful predictors of a positive test are an ejection fraction less than 40%, bundle branch block, or atrial fibrillation. | 電生理檢查是一種有創(chuàng)心臟監(jiān)測與心律失常誘發(fā)手段，對器質性心臟病或ECG異?；颊哌M行檢查時，其診斷率為50%（無器質性心臟病患者的診斷率為10%）。它是心律失常診斷的金標準。只是價格貴，且是有創(chuàng)性的。對射血分數小于40%及束支傳導阻滯或房性纖顫的陽性檢查效果最好?！?/td> |
| D. Tilt table testing | D. 傾斜試驗 |
| Tilt table testing is indicated for unexplained, recurrent syncope when arrhythmia or organic heart disease is excluded and neurocardiogenic syncope is suspected. In this setting, the sensitivity is 67% to 83% and specificity is 90%. | 在排除心律失?；蚱髻|性心臟病并懷疑有神經心源性暈厥時，就需要進行傾斜試驗，以對不明因復發(fā)性暈厥作出診斷。此項檢查的敏感性為67%～83%，特異性是90%?！?/td> |
| E. Echocardiogram and stress | E. 心臟超聲和運動負荷試驗 |
| Echocardiogram and stress tests are used only to evaluate exertional symptoms （echo first in this case） or suspected organic heart disease. | 心臟超聲和運動負荷試驗僅用于檢查勞力性癥狀（首選超聲）或可疑性器質性心臟病?！?/td> |
| F. Computed tomography | F. CT掃描。 |
| Computed tomography scan is used to evaluate focal neurologic signs. | CT掃描用于檢查局灶性神經病學體征?！?/td> |
| G. Electroencephalogram | G. 腦電圖（EEG） |
| Electroencephalogram is indicated for seizure activity only. | 腦電圖僅用于癲癇發(fā)作情況檢查?！?/td> |
| H. Carotid massage | H. 頸動脈按摩。 |
| Consider this if the patient is aged more than 60 years with unexplained syncope. Perform in the clinic if no bruits, ventricular tachycardia, recent stroke, or myocardial infarction. | 如病人年齡超過60歲并伴有不明因暈厥時可考慮此手法。如無心臟雜音、室性心動過速、新近中風或心梗，可在門診進行?！?/td> |
| I. Blood tests | I. 血液檢查。 |
| Blood tests, including hematocrit, serum chemistries, and pregnancy test, are not for screening; order only if a specific medical condition is suspected. | 血液檢查包括血細胞比容、血清化學和妊娠檢查。血液檢查不用于篩檢。僅在懷疑有特定疾病時使用?！?/td> |
| J. Psychiatric evaluation | J. 精神病檢查。 |
| Psychiatric evaluation is useful in the setting of a high recurrence rate in a young patient without resultant injuries and no evidence of organic heart disease. | 若年輕患者暈厥復發(fā)率高且未導致?lián)p傷、無器質性心臟疾病時，作精神病學檢查很有效?！?/td> |
| V. Diagnostic assessment | V. 診斷評估。 |
| The keys to the diagnosis of syncope are the history, physical examination, and ECG, yielding a diagnosis 45% of the time. The history and physical should focus on cardiac, neurologic, and medication-related issues. Directed testing can add 8% to diagnosis. Further classification by age and presence of organic heart disease can help focus evaluation and treatment. If organic heart disease is present or the ECG is abnormal, inpatient telemetry monitoring and electrophysiologic studies are recommended. If organic heart disease is not evident, ambulatory loop ECG and psychiatric evaluations are indicated, as well as possible tilt table testing. | 診斷暈厥的關鍵是病史、體格檢查和ECG，診斷率可達45%。病史和體檢的重點是心臟、神經和藥物相關問題。定向檢查可使診斷效率提高5%，進一步區(qū)分年齡和有無器質性心臟病有助于突出評價和治療。如有器質性心臟病或ECG異常，住院患者可進行遠程監(jiān)測和電生理檢查。如器質性心臟病不明顯就需要進行環(huán)路動態(tài)ECG和精神病學評估，可能的話再進行傾斜試驗。 |
| Although most syncope patients can be evaluated in the outpatient setting, hospitalization is recommended for those with organic heart disease, chest pain, a history or suspicion of arrhythmia, or presence of neurologic symptoms or signs suggesting transient ischemic attack or stroke. The extent of severity of the organic heart disease is the key determinant of mortality and should direct evaluation and therapy. Despite extensive evaluation and testing, the diagnosis may still be elusive in approximately 40% of patients with recurrent syncope, but fortunately these patients have a low incidence of morbidity and mortality. | 雖然多數暈厥患者可在門診部檢查，但對器質性心臟病、胸痛、有或疑有心律失?；颊摺⒒蛏窠泴W癥狀體征提示有暫短性心肌局部缺血和中風發(fā)生，建議住院檢查。器質性心臟病嚴重程度是死亡率的決定因素，應指導檢查并治療。盡管有廣泛的評估檢查，但仍有40%的復發(fā)性暈厥患者會漏診，幸運的是，這些病人的死亡率和發(fā)病率都很低?！?/td> |
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