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被动头高位倾斜及恢复至仰卧位后血流动力学反应的动态时间过程。

Dynamic time course of hemodynamic responses after passive head-up tilt and tilt back to supine position.

作者信息

Toska Karin, Walløe Lars

机构信息

Department of Physiology, Institute of Basic Medical Sciences, University of Oslo, N-0317 Oslo, Norway.

出版信息

J Appl Physiol (1985). 2002 Apr;92(4):1671-6. doi: 10.1152/japplphysiol.00465.2000.

Abstract

Mechanisms involved in the control of arterial pressure during postural changes were studied by analysis of the dynamic time course of cardiovascular changes during head-up tilt (HUT) and tilt back to supine position (TB). Beat-to-beat values of cardiovascular variables were recorded continuously before, during, and after passive HUT to 30 degrees in seven healthy humans. Left cardiac stroke volume (SV, Doppler ultrasound), mean arterial blood pressure (MAP), heart rate (HR), cardiac output (CO), and total peripheral conductance (TPC) were recorded. During HUT, MAP at the level of the carotid baroreceptors decreased by approximately 5 mmHg. There was a striking asymmetry between the time courses of cardiovascular changes on HUT and on TB. Adjustments generally took up to 30 s after HUT, whereas most changes were completed during the first 10 s after TB. Cardiovascular reflex adjustments of HR and TPC were more symmetrical. After HUT, SV was maintained during the first 4-6 s and then decreased steadily during the next 30 s to a stable level approximately 25% below its pretilt value. However, after TB, SV increased rapidly to its pretilt value in <10 s. This asymmetry in SV dynamics may be explained in part by a more rapid change in left cardiac filling after TB than after HUT. On TB, there must be a rapid inflow of stagnant blood from the legs, whereas venous valves will impede backward filling of veins in the lower body on HUT. In conclusion, we have revealed a characteristic asymmetry in cardiovascular responses to inverse variations in gravity forces in humans. This asymmetry can be explained in part by nonlinear, hydrodynamic factors, such as the one-way effect of venous valves in the lower part of the body.

摘要

通过分析头高位倾斜(HUT)和倾斜回仰卧位(TB)期间心血管变化的动态时间过程,研究了姿势改变过程中动脉压控制的相关机制。在7名健康受试者被动HUT至30度的过程中及前后,连续记录心血管变量的逐搏值。记录左心搏出量(SV,多普勒超声)、平均动脉血压(MAP)、心率(HR)、心输出量(CO)和总外周传导率(TPC)。在HUT期间,颈动脉压力感受器水平的MAP下降约5 mmHg。HUT和TB期间心血管变化的时间过程存在明显不对称。调整通常在HUT后30秒内完成,而大多数变化在TB后10秒内完成。HR和TPC的心血管反射调整更对称。HUT后,SV在前4 - 6秒内维持,然后在接下来的30秒内稳步下降至稳定水平,比倾斜前值低约25%。然而,TB后,SV在<10秒内迅速增加至倾斜前值。SV动力学的这种不对称部分可能是由于TB后左心充盈的变化比HUT后更快。在TB时,必须有来自腿部的停滞血液快速流入,而静脉瓣会阻碍HUT时下半身静脉的逆向充盈。总之,我们揭示了人类心血管对重力反向变化反应中的一种特征性不对称。这种不对称部分可以由非线性流体动力学因素解释,如下半身静脉瓣的单向作用。

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