Ogata Hisayoshi, Higuchi Yukiharu, Ogata Toru, Hoshikawa Shinya, Akai Masami, Nakazawa Kimitaka
Dept. of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-8555, Japan.
Clin Auton Res. 2009 Apr;19(2):113-22. doi: 10.1007/s10286-008-0504-x. Epub 2008 Dec 19.
To examine blood pressure responses during passive walking-like exercise in the standing posture (PWE) in spinal cord-injured (SCI) humans.
Twelve motor-complete SCI individuals (cervical level 6 to thoracic level 12, ASIA grade: A or B) and twelve able-bodied controls (CON) participated in this study. SCI individuals were divided into a group with injury level at or above thoracic (T) 6 (HSCI, n = 7) and a group with injury level at or below T10 (LSCI, n = 5). Subjects carried out 6-minute quiet standing and then 12-minute PWE at 1 Hz using a gait training apparatus that enables subjects to stand and move their legs passively.
Mean arterial blood pressures (MAPs) at standing in HSCI, LSCI and CON were 69 +/- 5, 83 +/- 4 and 93 +/- 2 mmHg, respectively. MAP changed significantly during PWE only in HSCI and CON, increasing to 88 +/- 4 (P < 0.001) and 98 +/- 1 mmHg (P < 0.01), respectively. The former group showed a larger increase in MAP (P < 0.001).
Spinal sympathetic reflexes can be induced in a region isolated from the brainstem in response to a stimulus originating below the level of the spinal cord injury, and the magnitude of increase in blood pressure is greater in SCI individuals with lesion level at or above T6 due to loss of supraspinal control of the major sympathetic outflow. This central mechanism may be one of the reasons why greater pressor response to PWE was observed in HSCI.
研究脊髓损伤（SCI）患者在站立姿势下进行被动步行样运动（PWE）时的血压反应。
12名运动完全性SCI患者（颈6至胸12水平，ASIA分级：A或B）和12名健全对照者（CON）参与了本研究。SCI患者被分为损伤水平在胸（T）6及以上的组（高位SCI，n = 7）和损伤水平在T10及以下的组（低位SCI，n = 5）。受试者先进行6分钟安静站立，然后使用一种能使受试者站立并被动移动腿部的步态训练装置，以1Hz的频率进行12分钟的PWE。
高位SCI组、低位SCI组和对照组站立时的平均动脉血压（MAP）分别为69±5、83±4和93±2 mmHg。仅在高位SCI组和对照组中，PWE期间MAP有显著变化，分别升至88±4（P < 0.001）和98±1 mmHg（P < 0.01）。前一组的MAP升高幅度更大（P < 0.001）。
脊髓交感反射可在与脑干分离的区域被诱发，以响应源自脊髓损伤水平以下的刺激，并且由于主要交感神经输出的脊髓上控制丧失，损伤水平在T6及以上的SCI患者血压升高幅度更大。这种中枢机制可能是高位SCI组对PWE观察到更大升压反应的原因之一。
