Schultz David M, Musley Shailesh, Beltrand Peggy, Christensen Jill, Euler Dave, Warman Eddy
Medical Advanced Pain Specialists (MAPS), Minneapolis, MN 55433, USA.
Pain Physician. 2007 Sep;10(5):677-85.
Several animal studies support the contention that thoracic spinal cord stimulation (SCS) might decrease arterial blood pressure.
To determine if electrical stimulation of the dorsal spinal cord in humans will lower mean arterial pressure (MAP) and heart rate (HR).
Case Series
Ten normotensive subjects that were clinically indicated for SCS testing were studied. Two of the 10 patients who underwent testing were excluded from the analysis because they did not respond to the Cold Pressor Test (CPT). Systolic blood pressure, diastolic blood pressure, and heart rate were measured continuously at the wrist (using the Vasotrac device). SCS was administered with quadripolar leads implanted into the epidural space under fluoroscopic guidance. SCS was randomly performed either in the T1-T2 or T5-T6 region of the spinal cord during normal conditions as well as during transient stress induced by CPT. The CPT was conducted by immersing the non-dominant hand in ice-cold water for 2 minutes.
There were moderate decreases in MAP and HR during SCS at the T5-T6 region compared to baseline that did not reach statistical significance. However, SCS at the T1-T2 region tended to increase MAP and HR compared to baseline but the change did not reach statistical significance. Arterial blood pressure was transiently elevated by 9.4 +/- 3.8 mmHg using CPT during the control period with SCS turned off and also during SCS at either the T1-T2 region or T5-T6 region of the spinal cord (by 9.2 +/- 5 mmHg and 10.7 +/- 8.4 mmHg, respectively). During SCS at T5-T6, the CPT significantly increased MAP by 5.9+/-7.1 mmHg compared to control CPT (SCS off).
This study demonstrated that SCS at either the T1-T2 or T5-T6 region did not significantly alter MAP or HR compared to baseline (no SCS). However, during transcient stress (elevated sympathetic tone) induced by CPT, there was a significant increase in MAP and moderate decrease in HR during SCS at T5-T6 region, which is not consistent with previous data in the literature. Acute SCS did not result in adverse cardiovascular responses and proved to be safe.
多项动物研究支持胸段脊髓刺激（SCS）可能降低动脉血压这一观点。
确定对人类背侧脊髓进行电刺激是否会降低平均动脉压（MAP）和心率（HR）。
病例系列
对10名临床上有SCS测试指征的血压正常受试者进行研究。10名接受测试的患者中有2名因对冷加压试验（CPT）无反应而被排除在分析之外。在手腕处连续测量收缩压、舒张压和心率（使用血管追踪装置）。在荧光透视引导下将四极导联植入硬膜外间隙进行SCS。在正常状态以及CPT诱发的短暂应激期间，SCS随机在脊髓的T1 - T2或T5 - T6区域进行。CPT通过将非优势手浸入冰冷水中2分钟来进行。
与基线相比，在T5 - T6区域进行SCS期间MAP和HR有中度下降，但未达到统计学显著性。然而，与基线相比，T1 - T2区域的SCS倾向于使MAP和HR升高，但变化未达到统计学显著性。在关闭SCS的对照期以及脊髓T1 - T2区域或T5 - T6区域进行SCS期间，使用CPT可使动脉血压短暂升高9.4±3.8 mmHg（分别为9.2±5 mmHg和10.7±8.4 mmHg）。在T5 - T6区域进行SCS期间，与对照CPT（SCS关闭）相比，CPT使MAP显著升高5.9±7.1 mmHg。
本研究表明，与基线（无SCS）相比，T1 - T2或T5 - T6区域的SCS均未显著改变MAP或HR。然而，在CPT诱发的短暂应激（交感神经张力升高）期间，T5 - T6区域进行SCS时MAP显著升高且HR中度下降，这与文献中的先前数据不一致。急性SCS未导致不良心血管反应，且证明是安全的。
