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WISE 2005:60天头低位卧床休息后脑血管自动调节功能改变

WISE 2005: altered cerebrovascular autoregulation after 60 day head-down bed rest.

作者信息

Greaves D K, Arbeille P, Hughson R L

机构信息

Cardiorespiratory & Vascular Dynamics Lab, Univ. Waterloo, Waterloo, Ontario, Canada.

出版信息

J Gravit Physiol. 2007 Jul;14(1):P61-2.

Abstract

We tested the hypothesis that 60 days of head-down bed rest (HDBR) would affect cerebrovascular autoregulation and that this change would be correlated with changes in tolerance to the upright posture. Twenty-four healthy women (32 +/- 4 yrs) participated in a 60-d bed rest study at the MEDES Clinic in Toulouse, France. End tidal CO2 (ETCO2), continuous blood pressure (BP), middle cerebral artery (MCA) velocity and time to presyncope (endpoint) were measured during an orthostatic tolerance test conducted before/after bed rest. Given the large range of change in tolerance even within assigned countermeasure groups, we separated subjects for this analysis on the basis of the change in endpoint (Delta endpoint) pre- to post-bed rest. Autoregulation and CO2 responsiveness were evaluated on a different day from a two-breath test with intermittent hypercapnic exposure. Autoregressive moving average (ARMA) modeled the two confounding inputs, BP and CO2, on cerebrovascular blood flow. The cerebrovascular resistance index (CVRi) was expected to decrease following a decrease in BP at the MCA to assist in maintenance of cerebral blood flow. Subjects with the smallest Delta endpoint after bed rest had a 78% increase in the gain of the BP --> CVRi response. Meanwhile, the groups with greater decline in orthostatic tolerance post-HDBR had no change in the gain of this response. ETCO2 was lower overall following HDBR, decreasing from 41.8 +/- 3.4 to 40.2 +/- 3.0 in supine rest, 37.9 +/- 3.4 to 33.3 +/- 4.0 in early tilt, and 29.5 +/- 4.4 to 27.1 +/- 5.1 at pre-syncope. There was however, higher MCA velocity at any ETCO2 for post- compared to pre-HDBR. In summary, changes in autoregulation were found only in those subjects who had the smallest change from pre- to post-HDBR orthostatic tolerance. The changes may assist in buffering changes in cerebral blood flow during orthostatic hypotension post-HDBR. The reduction in ETCO2 after bed rest might be due to a change in chemoreceptor response to blood CO2, but the cerebrovascular system seems to have completely compensated.

摘要

我们验证了以下假设

60天的头低位卧床休息(HDBR)会影响脑血管自动调节功能,且这种变化与直立姿势耐受性的变化相关。24名健康女性(32±4岁)参与了在法国图卢兹MEDES诊所进行的为期60天的卧床休息研究。在卧床休息前后进行的直立耐受性测试期间,测量了呼气末二氧化碳(ETCO2)、连续血压(BP)、大脑中动脉(MCA)血流速度以及出现前驱晕厥的时间(终点)。鉴于即使在指定的对策组内耐受性变化范围也很大,我们根据卧床休息前后终点的变化(Δ终点)对受试者进行了分组分析。在另一天通过间歇性高碳酸血症暴露的两次呼吸测试评估自动调节功能和二氧化碳反应性。自回归移动平均(ARMA)模型模拟了血压和二氧化碳这两个混杂输入对脑血管血流的影响。预计随着MCA处血压下降,脑血管阻力指数(CVRi)会降低,以协助维持脑血流量。卧床休息后Δ终点最小的受试者,其血压→CVRi反应增益增加了78%。同时,HDBR后直立耐受性下降较大的组,该反应增益没有变化。HDBR后ETCO2总体较低,仰卧休息时从41.8±3.4降至40.2±3.0,早期倾斜时从37.9±3.4降至33.3±4.0,前驱晕厥时从29.5±4.4降至27.1±5.1。然而,与HDBR前相比,在任何ETCO2水平下,HDBR后的MCA血流速度都更高。总之,仅在HDBR前后直立耐受性变化最小的受试者中发现了自动调节功能的变化。这些变化可能有助于缓冲HDBR后直立性低血压期间脑血流量的变化。卧床休息后ETCO2的降低可能是由于化学感受器对血液中二氧化碳的反应发生了变化,但脑血管系统似乎已经完全代偿。

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