神经源性直立性低血压患者直立倾斜试验血流动力学的特点

Hemodynamic characteristics of patients with neurogenic orthostatic hypotension in head-up tilt test

目的探讨神经源性直立性低血压(neurogenic orthostatic hypotension,nOH)患者直立倾斜试验血流动力学参数的特点。方法选取在我院晕厥门诊就诊并被诊断为典型nOH的患者。收集这些患者直立倾斜试验的血流动力学参数,包括平卧位和倾斜直立位的收缩压、舒张压、平均动脉压、心率、每搏量、心排血量和系统血管阻力,并进行回顾性分析。根据年龄进行分组,≥60岁组46例,<60岁组36例。比较两组患者在平卧位和倾斜直立位第1、2、3分钟上述血流动力学参数的特点。结果患者从平卧位至倾斜直立位,系统血管阻力均未增加。年龄≥60岁的患者,从平卧位到倾斜直立位,心率增加值、每搏量降低值及其变化幅度均较年龄<60岁患者更小。结论典型的nOH患者,从平卧位到倾斜直立位,系统血管阻力增加受损。<60岁的患者倾斜直立后心率增加和每搏量降低更显著。

Objective To investigate the hemodynamic parameter characteristics of patients with neurogenic orthostatic hypotension(nOH)in the head-up tilt test(HUTT).Methods Patients diagnosed with typical nOH in the syncope clinic of our hospital were selected.Hemodynamic parameters of these patients during HUTT including systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,stroke volume,cardiac output and systemic vascular resistance in the supine and tilted upright positions were collected,and retrospectively analyzed.The patients were divided into two groups according to age(age≥60 years group with 46 patients and age<60 years group with 36 patients).The characteristics of the above hemodynamic parameters were compared between the two groups in the supine position,and at the 1st,2nd,and 3rd minute in tilted upright position.Results For all patients,systemic vascular resistance does not increase from the supine to the tilted upright position.The increase of heart rate,the decrease of stroke volume and their degree of variability from the supine to the titled upright position are significantly lower in patients≥60 years than those in patients<60 years.Conclusion In patients with typical nOH,the increase of systemic vascular resistance from the supine position to the tilted upright position is impaired.Among these patients<60 years,heart rate increases and stroke volume decreases significantly in the tilted upright position.