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晕厥的诊断与治疗 指南摘要 PowerPoint PPT Presentation


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晕厥的诊断与治疗 指南摘要. By Duncan Deng.

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晕厥的诊断与治疗 指南摘要

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7009386

By Duncan Deng


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(syncope)20-30 =


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1. <1> <2> <3> <4> 2.

<1> <2> Shy-Drager<3> <4> 3<1> -<2> <3> <4> ICD


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5 <1> <2> <3> <4>

6 <1> <2> <3> <4>

4. <1> () <2> <3> <4> <5> <6> <7> <8>


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()

--1815%--17-2625%--17-4620%--40-591016%--40-591019%--701023%

  • >70

  • >=6%


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  • (II)

  • :

  • -(<45 y/o) -:0%,-: (,,)-

  • (I)

  • 1980()The Framingham study

  • 18-33% 0-12% 6% 24% 3-4%


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:->=45---(NSSTTC)

-: 4-7%->=3: 58-80%


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!


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: 38% to 47% 1-4

: 53% to 62%

  • 500,000 5

  • 170,000 6

  • 70,000 1-4

1Kapoor W, Med. 1990;69:160-175.

2 Silverstein M, et al. JAMA. 1982;248:1185-1189.

3 Martin G, et al. Ann Emerg. Med. 1984;12:499-504.

4 Kapoor W, et al. N Eng J Med. 1983;309:197-204.

5 National Disease and Therapeutic Index, IMS America, Syncope and Collapse #780.2; Jan 1997-Dec 1997.

6 Kapoor W, et al. Am J Med. 1987;83:700-708.


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/

1Linzer, J Clin Epidemiol, 1991.

2Linzer, J Gen Int Med, 1994.


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Entry Points

10.2 /1

3.2

1Reveal Syncope Validation Project (RSVP) Clinical Summary, Medtronic data on file


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82

  • :

  • :

    • ECG

Medtronic data on file


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    • ,

  • NHS

Medtronic data on file


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  • Diagnostic tests to determine

  • cause of syncope

  • EstimatedCost

  • History and Physical$160

  • ECG$168

  • Echocardiogram$592

  • Tilt Table Test$391

  • Carotid Sinus Massage$50

  • EP Study$3,663

  • Neurological Evaluation$125

  • Ear-nose-and-throat Evaluation$100

  • Total diagnostic costs$5,249

Trauma related visit for episode of care caused by syncopal event

  • EstimatedCost

  • Fractured forearm facility cost $111Physician costs$260

  • Facial laceration facility cost$111Physician costs$147

  • Total trauma-related costs$631

  • Total costs of syncopal episodes $ 5,880

Medtronic data on file


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!


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  • 5060/100/,12-15%6-820%

  • 1.

    2.

    3.

    4.


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3


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()()

() ()


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()

()


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(,)

()

(QT)


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()

5


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*Structural Heart Disease

MRI not studied

9 Day S, et al. Am J Med. 1982; 73: 15-23.

10 Stetson P, et al. PACE. 1999; 22 (part II): 782.

5Kapoor, JAMA, 1992

6 Krahn, Circulation, 1995

7 Krahn, Cardiology Clinics, 1997.

8 Eagle K,, et al. The Yale J Biol and Medicine. 1983; 56: 1-8.

1Kapoor, et al N Eng J Med, 1983.

2 Kapoor, Am J Med, 1991.

3 Linzer, et al. Ann Int. Med, 1997.

4 Kapoor, Medicine, 1990.


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!


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1992-20008ECG228832ACP1992-199757%ECG259%79%ECG


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10040%28%44%7075%ECG1826


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12QTHOLTERSAECG


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/


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Cammlau71%36%Fujimura218133237.5%15.4%""


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Raviele456035100%Natale60708092%92%80%90%


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  • 1-1.5

    Type 1 40

    4010

    Type 2

    4010

    IIA3IIB

    Type3 10%

    110%

    2130

60-80 degrees

1560-8045


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+

Sre862934%21573440%2326%

Fitzpatrick32232222971%10934%6821%3210%206%93715375%


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CTMRIKappor44322


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*Structural Heart Disease

MRI not studied

9 Day S, et al. Am J Med. 1982; 73: 15-23.

10 Stetson P, et al. PACE. 1999; 22 (part II): 782.

5Kapoor, JAMA, 1992

6 Krahn, Circulation, 1995

7 Krahn, Cardiology Clinics, 1997.

8 Eagle K,, et al. The Yale J Biol and Medicine. 1983; 56: 1-8.

1Kapoor, et al N Eng J Med, 1983.

2 Kapoor, Am J Med, 1991.

3 Linzer, et al. Ann Int. Med, 1997.

4 Kapoor, Medicine, 1990.


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!


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!


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  • 1. (, )

    2.


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  • A/B, ICDCRTCRTDACC/AHA


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  • .


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(Vasovagal syncope)/()


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  • Beta


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()

ACC/AHA IIaVVS

5/

40


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2(1)(2)


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(rate hysteresis)(rate-drop response)AAIVVIVDD


The north american vasovagal pacemaker study vps

(The North American Vasovagal Pacemaker StudyVPS)

()272(85.4%)


The vasovagal syncope international study vasis

(The Vasovagal Syncope International StudyVASIS)

1842DDI(19)(23)Ammirati 19DDI(8)DDD(11)


The vasovagal syncope international study vasis1

(The Vasovagal Syncope International StudyVASIS)

3.75%61%1DDI62.5%DDD25%17.7DDD1DDI3DDDDDI


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