脊髓损伤后体位性低血压的临床研究  

A clinical study of the orthostatic hypotension after spinal cord injury

作　　者：姚爱明[1] 关骅[2] 张贵平[2] 李雪梅[2] 胡胜军[2] 何慧[1] 

机构地区：[1]江苏徐州医学院附院康复科,221002 [2]中国康复研究中心

出　　处：《中国康复医学杂志》2005年第1期47-50,共4页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:探讨高位脊髓损伤患者发生体位性低血压(OH)的临床机制。方法:对45例高位脊髓损伤患者进行30°、60°、80°斜立试验,测量斜立后血压、脉搏、大脑中动脉血流(CBF)速度。根据斜立后是否出现体位性低血压症状,将患者分为有症状组和无症状组,进行对比性分析。结果:第1组24例患者无OH症状,能完成全部的测试;第2组21例患者均出现OH症状,18例因不能耐受体位性低血压症状而完成部分试验,3例完成全部试验。统计表明,无症状组平卧位与斜立位的血压差异有非常显著性意义,平卧位与斜立30°的脉搏、CBF速度差异无显著性意义,与斜立60°、80°差异有显著性意义。有症状组平卧位与斜立30°的CBF差异无显著性意义,斜立各角度间的CBF差异有显著性意义。两组在斜立30°时收缩压差异有显著性,而脉搏、CBF速度差异无显著性意义。结论:①脊髓损伤后早期,斜立30°15min不影响CBF速度,不出现OH症状;②血压下降并不是引起OH出现症状的直接原因,CBF速度下降是引起OH症状的直接原因。Objective: To study the mechanisms of the orthostatic hypotension(OH) after spinal cord injury.Method:Blood pressure and pulse and cerebral blood flow(CBF) in the middle cerebral artery were measured simultaneously while 45 cases who had suffered spinal cord injury above the T6 level did tilting-test on tilt table at 0,30,60 and 80degrees.All patients were divided into two groups,in the first group, 24 patients were asymptomatic of the OH, while in the second group 21 patients were symptomatic.Two groups were analysed in order to find the roles of the change in BP, pulse and CBF. Result: In the first group 24 patients finished tilting-test without any symptom of the OH, while in the second group 3 patients accomplished all tilting-test and have the OH symptoms,18 cases had to drop because of the severe symptoms of the OH during tilting test.By statistical analysis in the first group,there was very significant difference in BP between horizontal and tilting position. There is not significantly different in pulse and CBF at between 0 and 30 degrees,while significant difference at between 0 and 60 degrees between 0 and 80 degrees; In the symptomatic group,there was no significant difference in CBF between 0 and 30 degrees, while significant difference among 30,60,80 degrees.Between two groups,there was significantly different in systolic BP at 30 degrees, while no significant difference in pulse and CBF.Conclusion: ①Patient who suffered from spinal cord injury early may have no symptom of the OH while tilting at 30 degrees for CBF keeping relatively stable.②The auto-regulation of CBF play a dominant role in the adaptation to OH in patient with SCI, while BP is not the dominant factor.

关 键 词：脊髓损伤 体位性低血压 大脑 动脉血流速度 斜立试验 临床研究 

分 类 号：R651.2[医药卫生—外科学]