直立不耐受患者卧立位TCD脑血流临床分析

Clinical analysis of cerebral blood flow in patients with orthostatic intolerance by supine-to-standing TCD test

目的评估直立不耐受患者卧立位经颅多普勒(transcranial Dopplar,TCD)结果,探讨卧立位TCD脑血流动力学变化对直立不耐受综合征患者类型分型的影响及其卧立位脑血流的不同特点。方法回顾2018-09—2019-02海南医学院第二附属医院及南华大学第一附属医院具有直立不耐受症状或不明原因晕厥发作患者的临床资料,所有患者完成直立不耐受自评量表测评,共纳入102例直立不耐受患者,直立不耐受自评量表均有1项或以上症状出现。收集患者一般临床资料,包括卧位、立位1 min、5 min血压、心率,TCD采集脑血流动力学参数。结果依据卧立位血压、心率变化参数,本组患者57例无法分类,36例为直立性低血压(orthostatic hypotension,OH),直立性心动过速(postural orthostatic tachycardia syndrome,POTS)3例(2.9%),直立性高血压综合征(orthostatic hypertension syndrome,OHTN)3例(2.9%),阵发性窦性心动过速(paroxysmal sinus tachycardia,PST)3例(2.9%)。将卧立位TCD脑血流动力学参数加入分析后,之前归为正常反应类的57例患者中16例诊断为直立性脑低灌注综合征(orthostatic cerebral hypoperfusion syndrome,OCHOs),其中5例(31.3%)W波回调不全。36例OH患者中14例分类为直立性低血压不伴直立性脑低灌注(OH-compensated,OH-C),22例分类为直立性低血压伴直立性脑低灌注(OH-uncompensated,OH-U),OH-U组W波回调不全16例(72.7%),OH-C组W波回调不全5例(35.7%),POTS、PST、ONTN患者均无W波回调不全现象。结论卧立位TCD脑血流动力学监测有助于直立不耐受患者的诊断与鉴别诊断。

Objective:To explore the value of cerebral hemodynamics during supine-to-standing TCD test on diagnosis and clinical classification of patients with orthostatic intolerance,and its clinical significance.Methods:Patients with orthostatic intoler⁃ance and unexplained loss of consciousness who visited Outpatient and Inpatient Department of Neurology from September 2018 to February 2019 were enrolled.All patients completed the self-administered orthostatic intolerance questionnaire(OIQ),a total of 102 patients with erectile intolerance were included,and the OIQ had one or more symptoms.The general clinical information were collected,including blood pressure,heart rate and cerebral hemodynamic parameters during supine to standing TCD test were recorded in su⁃pine position and at 1 minute,3 minutes,5 minutes after standing.Results:A total of the 102 patients with orthostatic intolerance were enrolled for this study,and showed at lest one symptoms of orthostatic intolerance questionnaire.25(24.5%)were females,77(75.5%)were males.Age was 64(55-70)years old.The number of unclassified OI patients was 57 according to the parameters of blood pressure and heart rate during active-standing TCD test.36 were orthostatic hypotension(OH),3 were postural orthostatic tachycardia syndrome(POTS),3(2.9%)were orthostatic hypertension syndrome(OHTN),3(2.9%)were paroxysmal sinus tachycar⁃dia(PST);16/57 people were diagnosed as orthostatic cerebral hypoperfusion(OCHOs),when cerebral hemodynamic parameters during active standing TCD test was included in analysis.5/16 of the OCHOs patients were“W-spike”incomplecated(31.3%).14/36 of OH patients were(OH-compensated OH-C)and 22/36 were(OH-uncompensated OH-U).OH-U group with W-spike incomplecated was 72.7%,OH-C was 35.7%.The W-spike was present in POTS,PST and ONTN groups.Conclusion:Cerebral hemodynamic moni⁃toring during active standing TCD test have diagnosis and antidiastole value on OI syndrome.