单纯自主神经功能衰竭和多系统萎缩的两组慢性自主神经功能衰竭患者在头高位倾斜时血压突增的差异

• 作 者: Asahina M. Young T.M.r K. 陈云春
• 机 构: Department of Neurology, Chiba University, Graduate School of Medicine, 1- 8- 1 Inohana, Chuo- ku, C
• 出 处: 世界核心医学期刊文摘(神经病学分册)
• 发表日期: 2005年06期
• 关键词: 多系统萎缩 自主神经 头高位倾斜 突增 血压 头低位倾斜 收缩压 体位性低血压 基线值 水平位置

On head down tilt to the supine horizontal position (tilt reversal) after head up tilt (HUT), patients with orthostatic hypotension may show an increase in blood pressure (BP)- relative to baseline readings. We assessed this BP overshoot in 8 patients with pure autonomic failure (PAF,64 ± 13 years)- and 8 patients with multiple system atrophy (MSA, 66 ± 10 years). BP was intermittently measured during pre- tilt supine, HUT (60° , 10 min), and post- tilt supine periods. In addition, beat- to- beat BP was measured continuously using the Portapres model 2 device to calculate stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR). There was systolic BP overshoot of ≥ 15 mmHg after tilt reversal in 5 out of 8 PAF, but in only one of 8 MSA. A mean increase of systolic BP in PAF was significantly higher than that in MSA (p < 0.01). TPR increased over baseline level after tilt reversal, although there was no significant difference. SV and CO levels during the post- tilt supine period were similar to baseline levels. In conclusion, BP overshoot was prominent in the PAF group but not in the MSA group. The phenomenon of BP overshoot while supine, especially in PAF, may have implications for long term cardiac and vascular damage in such patients.

On head down tilt to the supine horizontal position (tilt reversal) after head up tilt (HUT), patients with orthostatic hypotension may show an increase in blood pressure (BP) - relative to baseline readings. We assessed this BP overshoot in 8 patients with pure autonomic failure (PAF, 64 ± 13 years) - and 8 patients with multiple system atrophy (MSA, 66 ± 10 years). BP was intermittently measured during pre- tilt supine, HUT (60 °, 10 min) In addition, beat-to-beat BP was measured continuously using the Portapres model 2 device to calculate stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR). There was systolic BP overshoot of ≥ A mean increase of systolic BP in PAF was significantly higher than that in MSA (p <0.01). TPR increased over baseline level after tilt reversal, although there was no significant difference. SV and CO levels during the post- In conclusion, BP overshoot was prominent in the PAF group but not in the MSA group. The phenomenon of BP overshoot while supine, especially in PAF, may have implications for long term cardiac and vascular damage in such patients.