盐酸米多君治疗不完全性高位脊髓损伤后体位性低血压的临床观察

Clinical observation of midodrine hydrochloride in treatment of orthostatic hypotension after incomplete cervical spinal cord injury

目的初步研究盐酸米多君治疗不完全性高位脊髓损伤后体位性低血压的疗效、斜床起立角度的耐受性及不良反应。方法将15例不完全性脊髓损伤后体位性低血压患者随机分为2组。对照组采用常规治疗,治疗组在常规治疗基础上加用盐酸米多君治疗(5 mg,po,tid)。所有病例于治疗前和治疗4周后测平卧位及斜床站立30°6、0°位时的血压。治疗前、治疗期间和治疗4周后密切观察临床表现,并进行血糖、肝肾功能、血常规、尿常规检查和B超残余尿量测定。结果不完全性高位脊髓损伤伴有体位性低血压患者治疗前及经盐酸米多君治疗4周后,治疗组与对照组平卧位时的血压无明显变化。治疗4周后斜床站立位的血压,治疗组明显提高(P<0.05),可耐受最大斜床站立角度明显提高(P<0.05)。治疗组患者中1例因卧位高血压,不能耐受退出研究;1例出现竖毛反应,未予特殊处理;1例出现肝功能轻度异常,停药护肝治疗后好转;1例残余尿轻度增加,予间歇导尿后改善。结论盐酸米多君可明显改善不完全性高位脊髓损伤所致的体位性低血压,不良反应轻微。

A/M To explore the effect of midodrine hydrochloride in the treatment of orthostatic hypotension after incomplete cervical spinal cord injury and to explore the adverse drug reactions. METHODS Fifteen patients with orthostatic hypotension after incomplete cervical spinal cord injury were randomly divided into 2 groups. The control group was received routine treatment while the experimental group was received routine treatment and midodrine hydrochloride（5 mg, po, tid）. The blood pressure of horizontal position and titling position with 30° and 60° was measured before and 4 weeks after treatment. The observation of clinical situation before treatment, during treatment and 4 weeks after treatment was performed. The blood glucose, liver function, renal function, blood routine and urine routine were detected and the residual urine volume for all patients were detected by ultrasound. RESULTS There was not significant difference in blood pressure in horizontal position between experimental group and control group before treatment and 4 weeks after treatment. Blood pressure was significantly raised and the maximal and the tolerated angle of titling position in experimental group was significantly raised 4 weeks after treatment （ P 〈 0.05）. There was a patient who withdrew from experimental group because of higher blood pressure in horizontal position after 4 weeks . One patient had abnormal liver function and had an improved condition after the withdrawal of midodrine hydrochloride. One patient with a slight increase in residual urine was improved after treatment by intermittent urethral catheterization. CONCLUSION Midodrine hydrochloride could raise the orthostatic hypotension of incomplete cervical spinal cord injury . It has little adverse drug reaction and better toleration.