Claydon V E, Steeves J D, Krassioukov A
International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada.
Spinal Cord. 2006 Jun;44(6):341-51. doi: 10.1038/sj.sc.3101855. Epub 2005 Nov 22.
Motor and sensory deficits are well-known consequences of spinal cord injury (SCI). During the last decade, a significant number of experimental and clinical studies have focused on the investigation of autonomic dysfunction and cardiovascular control following SCI. Numerous clinical reports have suggested that unstable blood pressure control in individuals with SCI could be responsible for their increased cardiovascular mortality. The aim of this review is to outline the incidence and pathophysiological mechanisms underlying the orthostatic hypotension that commonly occurs following SCI. We describe the clinical abnormalities of blood pressure control following SCI, with particular emphasis upon orthostatic hypotension. Possible mechanisms underlying orthostatic hypotension in SCI, such as changes in sympathetic activity, altered baroreflex function, the lack of skeletal muscle pumping activity, cardiovascular deconditioning and altered salt and water balance will be discussed. Possible alterations in cerebral autoregulation following SCI, and the impact of these changes upon cerebral perfusion are also examined. Finally, the management of orthostatic hypotension will be considered.
运动和感觉功能障碍是脊髓损伤（SCI）的常见后果。在过去十年中，大量的实验和临床研究集中于脊髓损伤后自主神经功能障碍和心血管控制的研究。众多临床报告表明，脊髓损伤患者血压控制不稳定可能是其心血管死亡率增加的原因。本综述的目的是概述脊髓损伤后常见的体位性低血压的发生率及病理生理机制。我们描述了脊髓损伤后血压控制的临床异常情况，尤其着重于体位性低血压。将讨论脊髓损伤中体位性低血压的可能机制，如交感神经活动的变化、压力反射功能改变、骨骼肌泵血活动缺失、心血管失健以及盐和水平衡改变。还将研究脊髓损伤后大脑自动调节的可能变化，以及这些变化对脑灌注的影响。最后，将考虑体位性低血压的管理。
