<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">一站就头晕、躺下就缓解,低血压?这个病因必须注意鉴别</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2022-05-16</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">王玉伟、金迪</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:医学界心血管频道</em></h2></div><p class="brief">得了个怪病,叫“站不住”……</p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">这次的委托人是一位坐在轮椅上的25岁女子,她一进门就说:“侦探,您可能觉得不可思议,但我真的不是装的,真的不是矫情!”<br/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我指着书架上一本《魍魉之匣》说道:“这世上没有不可思议的事,只存在可能存在之物,只发生可能发生之事。请说出您的故事,我会尽力帮助您。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">委托人缓缓道出自己的故事:“我从小就体质虚弱,以前就有肠易激综合征。5年前开始出这种荨麻疹,脸上、腋窝、前胸都有,还有皮肤变红。最近就更奇怪了,越来越‘站不住’,不是说没有力气,就是单纯的站不住,只要我站三五分钟就出汗、头晕,只要蹲下、躺下就能很快好转。有时候心跳能到每分钟180次,特别的怕热,晚上出汗特别多,睡觉的时候都得使用冰袋。别说是去工作了,去逛街都做不到……”<br/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我并没有表现出惊讶或疑问:“嗯,我已经有了初步的想法,我相信您不是在‘装病’。看来这种情况已经对您的生活造成了严重的影响,那您有没有寻求过帮助?”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">“帮助?我都快成小白鼠了!我查了一堆东西,吃了一堆药,还做了手术!” 委托人的情绪有些激动,废了好大劲才把这段坎坷的经历说清楚。</span></p><p><br/></p><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; white-space: normal; color: rgb(0, 0, 0); text-align: justify; outline: 0px; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; background-color: rgb(255, 255, 255); overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 17px 0px 0px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; border-width: 0px; border-style: none; border-color: initial; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 15px; margin: 3px auto; max-width: 100%; line-height: 24px; word-break: break-word; outline: 0px; border-width: 2px; border-style: solid; color: rgb(121, 121, 121); box-shadow: rgb(170, 170, 170) 0px 0px 3px; border-color: rgb(215, 0, 15); overflow-wrap: break-word !important; box-sizing: border-box !important;"><p style="padding: 0px; text-align: center; font-size: 16px; line-height: 1.75em; color: rgb(0, 0, 0); word-break: break-word; outline: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; font-weight: bolder; text-align: justify;">·<span style="padding: 0px; margin: 0px; overflow-wrap: break-word; letter-spacing: 0.544px;">侦探档案</span>·</span></p><p style="padding: 0px; font-size: 16px; line-height: 1.75em; color: rgb(0, 0, 0); word-break: break-word; outline: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px;"></span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1.动态心电图发现了窦性心动过速、房性期前收缩(图1、图2)。其余多项检查未见有意义改变。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2.服用IC类抗心律失常药物、β受体阻滞剂,出现低血压、乏力,停药。<br/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">3.进行了消融治疗,效果欠佳</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">4.服用伊伐布雷定,出现了闪光现象,停药。</span></p><p><br/></p><p style="text-align: center;"><img src="https://studioyszimg.yxj.org.cn/2022040522501400215.png" title="" alt=""/><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">&nbsp;</span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图1. 动态心电图发现窦性心动过速</span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">&nbsp;</span></p><p style="text-align: center;"><img src="https://studioyszimg.yxj.org.cn/2022040522502600216.png" title="" alt=""/><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">&nbsp;</span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图2. 动态心电图发现房性期前收缩</span></p></section></section></section></section><p style="padding: 0px; text-align: justify; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; background-color: rgb(255, 255, 255);"><span style="font-family: -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif;"><br/></span></p><p style="padding: 0px; text-align: justify; overflow-wrap: break-word; white-space: normal; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; background-color: rgb(255, 255, 255);"><span style="font-family: -apple-system-font, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif;">我思考之后慢慢说出:“像您这么年轻的女性,很少有器质性心脏病,自主神经功能紊乱的倒是很常见。荨麻疹我不了解,但是肠易激综合征我是听说过的,这跟自主神经功能紊乱也有关联。我需要你做个试验来进一步印证,不不不,不用太紧张,这个试验很简单。”</span><br/></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">说罢,我向波仔招招手、吩咐了几句,没过多久,试验结果就出现在了我的面前。</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><br/></span></p><section style="white-space: normal; padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; color: rgb(0, 0, 0); text-align: justify; outline: 0px; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; background-color: rgb(255, 255, 255); overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 17px 0px 0px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; border-width: 0px; border-style: none; border-color: initial; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 15px; margin: 3px auto; max-width: 100%; line-height: 24px; word-break: break-word; outline: 0px; border-width: 2px; border-style: solid; color: rgb(121, 121, 121); box-shadow: rgb(170, 170, 170) 0px 0px 3px; border-color: rgb(215, 0, 15); overflow-wrap: break-word !important; box-sizing: border-box !important;"><p style="padding: 0px; text-align: center; font-size: 16px; line-height: 1.75em; color: rgb(0, 0, 0); word-break: break-word; outline: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; font-weight: bolder; text-align: justify;">·<span style="padding: 0px; margin: 0px; overflow-wrap: break-word; letter-spacing: 0.544px;">侦探档案</span>·</span></p><p style="padding: 0px; font-size: 16px; line-height: 1.75em; color: rgb(0, 0, 0); word-break: break-word; outline: 0px; max-width: 100%; overflow-wrap: break-word !important; box-sizing: border-box !important;"><br/></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px;"></span></p><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"></span></p><p style="white-space: normal; text-align: justify;"><span style="font-size: 16px; line-height: 28px; font-weight: bold; text-align: left; color: rgb(0, 0, 0);">主动站立测试结果 :</span></p><p style="white-space: normal;"><br/></p><p style="white-space: normal; text-align: center;"><img src="https://studioyszimg.yxj.org.cn/2022040522520600219.png" title="" alt=""/></p><p><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);"></span></p></section></section></section></section><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;"></span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><br/></span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我看着试验结果,说道:“试验结果很明显,直立不耐受病程超过半年,直立试验后心率增快而无低血压,答案已经呼之欲出。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">委托人显然有些震惊:“就这么简单?这就结束了?”<br/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我说:“差不多了,你需要再留一整天的尿,还要再抽一管血。你不需要紧张,这不严重,相信我就是你要找到神探。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">第二天,尿检结果出来,24小时尿儿茶酚胺含量明显增高,血浆去甲肾上腺素水平为11121pg /ml,我说出了那个埋藏已久的答案:“高肾上腺素能性POTS。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">不光是委托人,波仔也有些疑惑,他问道:“老大,第一次提到的名词不要用英文缩写,这是常识。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我耸耸肩:“这个名字太长了,说全了你会记不住。POTS是<strong>体位性心动过速综合征</strong>,这是一种一种伴有心动过速表现的直立不耐受,15至35岁女性多发、平均年龄为23.4岁。可在直立后出现心动过速、脑灌注不足、自主神经过速激活的症状,平卧位后症状减轻或消失。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">委托人也问:“从表现来说,确实非常像,也就是在一开始您就确定我是POTS了?”<br/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我说:“刚开始我还是怀疑,因为POTS还要跟IST——‘不适当窦性心动过速’相鉴别,它们二者都主要影响年轻女性,症状经常重叠。但是IST并不会因为直立而加重症状,平均心率也比POTS的更高,并且没有典型的高心率峰值。在看到体位试验的结果时,我就基本确定是POTS,下面就是明确是那种分型了。”</span></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);"><br/></span></p><section style="white-space: normal; padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; color: rgb(0, 0, 0); text-align: justify; outline: 0px; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; background-color: rgb(255, 255, 255); overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 15px 8px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; text-align: center; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px 10px 10px; margin: 0px; display: inline-block; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; border-color: rgb(204, 0, 0) rgb(62, 62, 62) rgb(62, 62, 62); border-radius: 10px; border-style: solid; border-width: 2px 0px 0px; box-shadow: rgb(152, 152, 152) 0px 0px 2px; vertical-align: top; width: 549.09px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 0px 0px 15px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px 10px; margin: 0px; display: inline-block; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; background-color: rgb(204, 0, 0); border-bottom-left-radius: 0.5em; border-bottom-right-radius: 0.5em; color: rgb(255, 255, 255); vertical-align: top; overflow-wrap: break-word !important; box-sizing: border-box !important;"><p style="padding: 0px; text-align: justify; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; min-height: 1em; max-width: 100%; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="padding: 0px; margin: 0px; max-width: 100%; font-weight: bolder; outline: 0px; line-height: 28px; color: rgb(255, 255, 255); overflow-wrap: break-word !important; box-sizing: border-box !important;">侦探贴纸1</span></p></section></section><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 1.75em; word-break: break-word; outline: 0px; text-align: justify; overflow-wrap: break-word !important; box-sizing: border-box !important;"><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"><br/></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; font-weight: bolder;"></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; font-weight: bolder;"></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px; font-weight: bold; text-align: left;"></span></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px; font-weight: bold; text-align: left;"></span></p><p style="white-space: normal; text-align: justify;"><span style="font-size: 16px; line-height: 28px; font-weight: bold; text-align: left; color: rgb(0, 0, 0);">体位性心动过速综合征(POTS)诊断标准</span></p><p style="white-space: normal;"><br/></p><p style="white-space: normal; text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1.至少持续6个月的直立性不耐受;</span></p><p style="white-space: normal;"><br/></p><p style="white-space: normal; text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2.直立或直立倾斜试验10分钟内心率增加≥30次/分(小于19岁≥40次/分);</span></p><p style="white-space: normal;"><br/></p><p style="white-space: normal; text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">3.直立心率超过120次/分;</span><span style="font-size: 16px; letter-spacing: 0.544px;">无直立性低血压表现。</span></p></section></section></section></section></section><p style="white-space: normal; padding: 0px; text-align: justify; overflow-wrap: break-word; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; background-color: rgb(255, 255, 255);"><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-title-one" style="font-size: 16px; line-height: 28px; font-weight: bold; color: rgb(215, 0, 15); text-align: left;"></span></p><section style="white-space: normal; padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; color: rgb(0, 0, 0); text-align: justify; outline: 0px; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; background-color: rgb(255, 255, 255); overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 15px 8px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; text-align: center; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px 10px 10px; margin: 0px; display: inline-block; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; border-color: rgb(204, 0, 0) rgb(62, 62, 62) rgb(62, 62, 62); border-radius: 10px; border-style: solid; border-width: 2px 0px 0px; box-shadow: rgb(152, 152, 152) 0px 0px 2px; vertical-align: top; width: 549.09px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 0px 0px 15px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px 10px; margin: 0px; display: inline-block; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; background-color: rgb(204, 0, 0); border-bottom-left-radius: 0.5em; border-bottom-right-radius: 0.5em; color: rgb(255, 255, 255); vertical-align: top; overflow-wrap: break-word !important; box-sizing: border-box !important;"><p style="padding: 0px; text-align: justify; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; min-height: 1em; max-width: 100%; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="padding: 0px; margin: 0px; max-width: 100%; font-weight: bolder; outline: 0px; line-height: 28px; color: rgb(255, 255, 255); overflow-wrap: break-word !important; box-sizing: border-box !important;">侦探贴纸2</span></p></section></section><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 1.75em; word-break: break-word; outline: 0px; text-align: justify; overflow-wrap: break-word !important; box-sizing: border-box !important;"><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"><br/></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; font-weight: bolder;"></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; font-weight: bolder;"></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px; font-weight: bold; text-align: left;"></span></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px; font-weight: bold; text-align: left;"></span></p><p><span style="font-size: 16px; line-height: 28px; font-weight: bold; text-align: left;"></span></p><p style="text-align: justify;"><span style="font-size: 16px; line-height: 28px; font-weight: bold; text-align: left; color: rgb(0, 0, 0);">不适当窦性心动过速(IST):</span><span style="font-size: 16px; letter-spacing: 0.544px;">24小时内的静息心率&gt;100 bpm,平均心率至少为90 bpm。排除贫血、甲状腺功能异常、低血容量、药物等导致窦性心动过速的因素。排除其他房性心动过速。其根本机制尚不清楚。</span></p><p><br/></p><p style="text-align: center;"><img src="https://studioyszimg.yxj.org.cn/2022040522504000217.png" title="" alt=""/><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">&nbsp;</span></p><p style="text-align: center;"><span style="line-height: 28px; font-size: 14px; color: rgb(136, 136, 136);">图3. POTS与IST心率曲线比较</span></p></section></section></section></section></section><p style="white-space: normal; padding: 0px; text-align: justify; overflow-wrap: break-word; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; background-color: rgb(255, 255, 255);"><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我继续说道:“POTS还分为高肾上腺素能性、神经性、低血容量性等,可以通过儿茶酚胺检测、皮肤活检、血容量评估、免疫检测等方法进一步分型。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">波仔恍然大悟:“尿儿茶酚胺、血浆去甲肾上腺素明显升高,所以是高肾上腺素能性的!”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">委托人有些疑问:“可您只让我儿茶酚胺和血浆去甲肾上腺素,可见您当时就确信我是高肾上腺素能这种分型,是不是因为这种分型最多?”<br/></span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我解释道:“我之所以这么确定,并不是依靠发病率,而是每种分型的表现不同。高肾上腺素能性POTS只占POTS的30%,其去甲肾上腺素会升高至600 pg/ml以上,这种POTS在体位试验中,血压、心率升高更明显,头痛、头晕等症状的比例也更高。而神经性POTS多表现为外周自主神经功能受损,比如下肢远端出汗减少,其他症状较少,对生活质量的影响也更小,体位试验对心率影响也小。而低血容量POTS,尽管循环容量降低,血浆肾素活性却没有代偿性增加。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">委托人有些泄气:“看来我这种分型是最严重的。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我连忙安慰:“这种POTS症状虽然明显,治疗却不复杂,像可乐定、甲基多巴这种减少交感神经系统活性的药物就是治疗的核心,此外穿紧身衣,多喝水,多吃盐对治疗也有帮助。而且我这里还有一个好消息。”</span></p><p><br/></p><section style="white-space: normal; padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; color: rgb(0, 0, 0); text-align: justify; outline: 0px; font-family: -apple-system, BlinkMacSystemFont, &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, &quot;Microsoft YaHei UI&quot;, &quot;Microsoft YaHei&quot;, Arial, sans-serif; letter-spacing: 0.544px; background-color: rgb(255, 255, 255); overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 15px 8px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; text-align: center; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px 10px 10px; margin: 0px; display: inline-block; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; border-color: rgb(204, 0, 0) rgb(62, 62, 62) rgb(62, 62, 62); border-radius: 10px; border-style: solid; border-width: 2px 0px 0px; box-shadow: rgb(152, 152, 152) 0px 0px 2px; vertical-align: top; width: 549.09px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 0px 0px 15px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px 10px; margin: 0px; display: inline-block; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; background-color: rgb(204, 0, 0); border-bottom-left-radius: 0.5em; border-bottom-right-radius: 0.5em; color: rgb(255, 255, 255); vertical-align: top; overflow-wrap: break-word !important; box-sizing: border-box !important;"><p style="padding: 0px; text-align: justify; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; min-height: 1em; max-width: 100%; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><span style="padding: 0px; margin: 0px; max-width: 100%; font-weight: bolder; outline: 0px; line-height: 28px; color: rgb(255, 255, 255); overflow-wrap: break-word !important; box-sizing: border-box !important;">侦探贴纸3</span></p></section></section><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 30px; word-break: break-word; outline: 0px; overflow-wrap: break-word !important; box-sizing: border-box !important;"><section style="padding: 0px; margin: 0px; max-width: 100%; line-height: 1.75em; word-break: break-word; outline: 0px; text-align: justify; overflow-wrap: break-word !important; box-sizing: border-box !important;"><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"><br/></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; font-weight: bolder;"></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; font-weight: bolder;"></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word;"></span></span></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px; font-weight: bold; text-align: left;"></span></p><p style="padding: 0px; text-align: center; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; font-weight: bolder;"><span class="ysz-ueditor-content" style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px;"></span></span></p><p style="padding: 0px; overflow-wrap: break-word; font-size: 16px; line-height: 28px; word-break: break-word;"><span style="padding: 0px; margin: 0px; overflow-wrap: break-word; line-height: 28px; font-weight: bold; text-align: left;"></span></p><p><span style="font-size: 16px; line-height: 28px; font-weight: bold; text-align: left;"></span></p><p><span style="font-size: 16px; line-height: 28px; font-weight: bold; text-align: left;"></span></p><p style="white-space: normal; text-align: justify;"><span style="font-size: 16px; line-height: 28px; font-weight: bold; text-align: left; color: rgb(0, 0, 0);">POTS的治疗:</span><span style="font-size: 16px; letter-spacing: 0.544px;">治疗分为非药物治疗和药物治疗。非药物治疗包括健康教育、运动锻炼、生活指导、增加水钠摄入;药物治疗包括氢化可的松、β受体阻滞剂、α受体激动剂、5-羟色胺再摄取抑制剂、促红细胞生成素、奥曲肽等。</span></p></section></section></section></section></section><p style="white-space: normal; padding: 0px; text-align: justify; overflow-wrap: break-word; font-size: 16px; line-height: 28px; color: rgb(0, 0, 0); word-break: break-word; font-family: &quot;Microsoft Yahei&quot;, Helvetica, Arial, sans-serif; background-color: rgb(255, 255, 255);"><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">看到委托人逐渐露出喜色,我继续说:“我昨天咨询了免疫学专家,发现了另外一条导致心动过速的原因——肥大细胞疾病。肥大细胞疾病可以导致面部潮红、腹部不适、荨麻疹、皮肤纹状症,而且过度的组胺释放也可以加重直立性不耐受的症状。”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">再后来,我为她联系了免疫学专家。她的荨麻疹考虑为“肥大细胞活化综合症”所致。在调整生活方式的同时,她使用了抗组胺药、孟鲁司特、色甘酸钠、可乐定等药物综合治疗。经过综合治疗后,她仍然有体位性心动过速,但心率升高并不明显,其他症状得到改善,还可以进行徒步运动。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">我和波仔都把这个案子称为“站不住案”,卷宗放在“躺不下案”的旁边。</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">您问我什么是“躺不下案?”</span></p><p><br/></p><p style="text-align: justify;"><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">嗯,那也是一个有趣的故事,就让我们下回分解!</span></p><p><br/></p><p style="text-align: center;"><img src="https://studioyszimg.yxj.org.cn/2022040522494000214.png" title="" alt=""/><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">&nbsp;</span></p><p><br/></p><p style="text-align: center;"><img src="https://studioyszimg.yxj.org.cn/2022040522510100218.jpg" title="" alt=""/></p><!--auditorInfo--><div class="footer"><div class="item"><p class="ysz-ueditor-references-label" >参考文献 <span>共3篇<i></i></span></p><div class="ysz-ueditor-references-content textLine2" lang="en"><p>[1]<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://xueshu.baidu.com/usercenter/paper/show?paperid=21c3e4c3c8449864dc9d17db09c2696b&amp;site=xueshu_se&quot;}">Feigofsky S, Fedorowski A. Defining Cardiac Dysautonomia - Different Types, Overlap Syndromes; Case-based Presentations</span></p><p>[2]&nbsp;<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://book.kongfz.com/12312/4582225483&quot;}">陈灏珠, 何梅先, 魏盟, 等. 实用心脏病学(第五版)[M]. 上海科学技术出版社, 2016.</span></p><p>[3]<span class="appskip" data-appskip="yxjysz" data-appskipobj="{&quot;type&quot;:18,&quot;id&quot;:0,&quot;title&quot;:&quot;&quot;,&quot;url&quot;:&quot;https://xueshu.baidu.com/usercenter/paper/show?paperid=d7188870433d409868c4e4ebca0f6e41&amp;site=xueshu_se&quot;}">中华医学会儿科学分会心血管学组,《中华儿科杂志》编辑委员会,北京医学会儿科学分会心血管学组,等. 儿童血管迷走性晕厥及体位性心动过速综合征治疗专家共识[J]. 中华儿科杂志, 2018, 56(1):6-9.</span></p><p> <br/></p></div></div>

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