Статья
Изменение образа жизни как метод лечения вазовагальных обмороков
Вазовагальные обмороки являются наиболее частой причиной утраты сознания. Необходимость их лечения обусловлена снижением качества жизни пациентов, а также риском получения травмы в результате падения. В настоящее время нет лекарственных препаратов, эффективность которых в предупреждении вазовагальных обмороков была бы доказана в крупных рандомизированных плацебо‐контролируемых исследованиях. В то же время данные о патогенезе развития вазовагальной реакции, факторах ее провокации позволяют эффективно использовать немедикаментозные методы (такие как обучение пациента, физические тренировки, использование маневров) в лечении больных с вазовагальными обмороками.
1. Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ et al. Incidence and Prognosis of Syncope. New England Journal of Medicine. 2002;347(12):878–85. DOI: 10.1056/NEJMoa012407
2. Savage DD, Corwin L, McGee DL, Kannel WB, Wolf PA. Epidemiologic features of isolated syncope: the Framingham Study. Stroke. 1985;16(4):626–9. DOI: 10.1161/01.STR.16.4.626
3. Lieshout JJ, Wieling W, Karemaker JM. Neural Circulatory Control in Vasovagal Syncope. Pacing and Clinical Electrophysiology. 1997;20(3):753–63. DOI: 10.1111/j.1540-8159.1997.tb03901.x
4. Linzer M, Pontinen M, Gold DT, Divine GW, Felder A, Blair Brooks W. Impairment of physical and psychosocial function in recurrent syncope. Journal of Clinical Epidemiology. 1991;44(10):1037–43. DOI: 10.1016/0895-4356(91)90005-T
5. Певзнер А.В., Кучинская Е.А. Лечение вазовагальных обмороков: успехи, разочарования, перспективы. Consilium Medicum. 2008;10(5):24-30
6. Grubb BP. Pathophysiology and differential diagnosis of neurocardiogenic syncope. The American Journal of Cardiology. 1999;84(8):3–9. DOI: 10.1016/S0002-9149(99)00691-8
7. Sutton R, Bloomfield DM. Indications, methodology, and classification of results of tilt-table testing. The American Journal of Cardiology. 1999;84(8):10–9. DOI: 10.1016/S0002-9149(99)00692-X
8. Vyas A, Swaminathan PD, Zimmerman MB, Olshansky B. Are treatments for vasovagal syncope effective? A meta-analysis. International Journal of Cardiology. 2013;167(5):1906–11. DOI: 10.1016/j.ijcard.2012.04.144
9. Кучинская Е.А., Певзнер А.В., Вершута Е.В., Альбицкая К.В., Хеймец Г.И., Рогоза А.Н. и др. Сравнительная эффективность и переносимость атенолола и мидодрина при лечении больных с вазовагальными обмороками. Терапевтический Архив. 2006;78(4):64-8
10. Salim MA, Di Sessa TG. Effectiveness of fludrocortisone and salt in preventing syncope recurrence in children. Journal of the American College of Cardiology. 2005;45(4):484–8. DOI: 10.1016/j.jacc.2004.11.033
11. Schroeder C, Birkenfeld AL, Mayer AF, Tank J, Diedrich A, Luft FC et al. Norepinephrine Transporter Inhibition Prevents Tilt-Induced Pre-Syncope. Journal of the American College of Cardiology. 2006;48(3):516–22. DOI: 10.1016/j.jacc.2006.04.073
12. Sheldon R. Prevention of Syncope Trial (POST): a randomized clinical trial of beta blockers in the prevention of vasovagal syncope Rationale and study design. Europace. 2003;5(1):71–5. DOI: 10.1053/eupc.2002.0284
13. Sheldon R, Raj SR, Rose MS, Morillo CA, Krahn AD, Medina E et al. Fludrocortisone for the Prevention of Vasovagal Syncope. A randomized, placebo-controlled trial. Journal of the American College of Cardiology. 2016;68(1):1–9. DOI: 10.1016/j.jacc.2016.04.030
14. Raj SR, Faris PD, McRae M, Sheldon RS. Rationale for the prevention of syncope trial IV: assessment of midodrine. Clinical Autonomic Research. 2012;22(6):275–80. DOI: 10.1007/s10286-012-0167-5
15. Sheldon RS, Morillo CA, Klingenheben T, Krahn AD, Sheldon A, Rose MS. Age-Dependent Effect of β-Blockers in Preventing Vasovagal Syncope. Circulation: Arrhythmia and Electrophysiology. 2012;5(5):920–6. DOI: 10.1161/CIRCEP.112.974386
16. Sheldon R, Raj S, Guzman J, Kus T, Ayala-Paredes F, Angihan J et al. A proof of principle study of atomoxetine for the prevention of vasovagal syncope: POST 6. Canadian Journal of Cardiology. 2018;34(10):S137–8. DOI: 10.1016/j.cjca.2018.07.198
17. Shen W-K, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope. Journal of the American College of Cardiology. 2017;70(5):e39–110. DOI: 10.1016/j.jacc.2017.03.003
18. Brignole M, Moya A, de Lange FJ, Deharo J-C, Elliott PM, Fanciulli A et al. 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart Journal. 2018;39(21):1883–948. DOI: 10.1093/eurheartj/ehy037
19. Чазов Е.И., Голицын С.П. Руководство по нарушениям ритма сердца. М.: ГЭОТАР-Медиа, 2008. -414c. ISBN 978-5-9704-0845-2
20. Brignole M, Moya A, de Lange FJ, Deharo J-C, Elliott PM, Fanciulli A et al. Practical Instructions for the 2018 ESC Guidelines for the diagnosis and management of syncope. European Heart Journal. 2018;39(21):e43–80. DOI: 10.1093/eurheartj/ehy071
21. Khurana RK, Lynch JJ, Craig FW. A novel psychophysiological treatment for vasovagal syncope. Clinical Autonomic Research. 1997;7(4):191–7. DOI: 10.1007/BF02267981
22. Van Dijk N, Velzeboer SCJM, Destree-Vonk A, Linzer M, Wieling W. Psychological Treatment of Malignant Vasovagal Syncope Due to Bloodphobia. Pacing and Clinical Electrophysiology. 2001;24(1):122–4. DOI: 10.1046/j.1460-9592.2001.00122.x
23. Duygu H, Zoghi M, Turk U, Akyuz S, Ozerkan F, Akilli A et al. The Role of Tilt Training in Preventing Recurrent Syncope in Patients with Vasovagal Syncope: A Prospective and Randomized Study. Pacing and Clinical Electrophysiology. 2008;31(5):592–6. DOI: 10.1111/j.1540-8159.2008.01046.x
24. Foglia-Manzillo G. Efficacy of tilt training in the treatment of neurally mediated syncope. A randomized study. Europace. 2004;6(3):199–204. DOI: 10.1016/j.eupc.2004.01.002
25. El-Sayed H, Hainsworth R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart. 1996;75(2):134–40. DOI: 10.1136/hrt.75.2.134
26. Chu W, Wang C, Wu L, Lin P, Li F, Zou R. Oral Rehydration Salts: An Effective Choice for the Treatment of Children with Vasovagal Syncope. Pediatric Cardiology. 2015;36(4):867–72. DOI: 10.1007/s00246-015-1097-5
27. Jordan J, Shannon JR, Black BK, Ali Y, Farley M, Costa F et al. The Pressor Response to Water Drinking in Humans: A Sympathetic Reflex? Circulation. 2000;101(5):504–9. DOI: 10.1161/01.CIR.101.5.504
28. Rossi P, Andriesse GI, Oey PL, Wieneke GH, Roelofs JMM, Akkermans LMA. Stomach distension increases efferent muscle sympathetic nerve activity and blood pressure in healthy humans. Journal of the Neurological Sciences. 1998;161(2):148–55. DOI: 10.1016/S0022-510X(98)00276-7
29. Solari D, Tesi F, Unterhuber M, Gaggioli G, Ungar A, Tomaino M et al. Stop vasodepressor drugs in reflex syncope: a randomised controlled trial. Heart. 2017;103(6):449–55. DOI: 10.1136/heartjnl-2016-309865
30. Henderson Y, Oughterson AW, Greenberg LA, Searle CP. Muscle tonus, intramuscular pressure and the venopressor mechanism. American Journal of Physiology-Legacy Content. 1935;114(2):261–8. DOI: 10.1152/ajplegacy.1935.114.2.261
31. Engel GL, Romano J. Studies of Syncope: IV. Biologic Interpretation of Vasodepressor Syncope. Psychosomatic Medicine. 1947;9(5):288– 94. DOI: 10.1097/00006842-194709000-00002
32. Weissler AM, Warren JV, Estes EH, Mcintosh HD, Leonard JJ. Vasodepressor Syncope: Factors Influencing Cardiac Output. Circulation. 1957;15(6):875–82. DOI: 10.1161/01.CIR.15.6.875
33. Öst L-G, Sterner U, Fellenius J. Applied tension, applied relaxation, and the combination in the treatment of blood phobia. Behaviour Research and Therapy. 1989;27(2):109–21. DOI: 10.1016/0005-7967(89)90069-7
34. Ten Harkel ADJ, Van Lieshout JJ, Wieling W. Effects of Leg Muscle Pumping and Tensing on Orthostatic Arterial Pressure: A Study in Normal Subjects and Patients with Autonomic Failure. Clinical Science. 1994;87(5):553–8. DOI: 10.1042/cs0870553
35. Krediet CTP, de Bruin IGJM, Ganzeboom KS, Linzer M, van Lieshout JJ, Wieling W. Leg crossing, muscle tensing, squatting, and the crash position are effective against vasovagal reactions solely through increases in cardiac output. Journal of Applied Physiology. 2005;99(5):1697–703. DOI: 10.1152/japplphysiol.01250.2004
36. Brignole M, Croci F, Menozzi C, Solano A, Donateo P, Oddone D et al. Isometric arm counter-pressure maneuvers to abort impending vasovagal syncope. Journal of the American College of Cardiology. 2002;40(11):2053–9. DOI: 10.1016/S0735-1097(02)02683-9
37. van Dijk N, Quartieri F, Blanc J-J, Garcia-Civera R, Brignole M, Moya A et al. Effectiveness of Physical Counterpressure Maneuvers in Preventing Vasovagal Syncope. Journal of the American College of Cardiology. 2006;48(8):1652–7. DOI: 10.1016/j.jacc.2006.06.059
38. Певзнер А.В., Кучинская Е.А., Альбицкая К.В., Егорова Е.А., Хеймец Г.И., Рогоза А.Н. и др. Эффективность компрессионной терапии нижних конечностей при лечении больных вазовагальными обмороками. Терапевтический Архив. 2007;79(1):52-5