Krassioukov Andrei, Eng Janice J, Warburton Darren E, Teasell Robert
International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.
Arch Phys Med Rehabil. 2009 May;90(5):876-85. doi: 10.1016/j.apmr.2009.01.009.
To review systematically the evidence for the management of orthostatic hypotension (OH) in patients with spinal cord injuries (SCIs).
A key word literature search was conducted of original and review articles as well as practice guidelines using Medline, CINAHL, EMBASE, and PsycInfo, and manual searches of retrieved articles from 1950 to July 2008, to identify literature evaluating the effectiveness of currently used treatments for OH.
Included randomized controlled trials (RCTs), prospective cohort studies, case-control studies, pre-post studies, and case reports that assessed pharmacologic and nonpharmacologic intervention for the management of OH in patients with SCI.
Two independent reviewers evaluated the quality of each study, using the Physiotherapy Evidence Database score for RCTs and the Downs and Black scale for all other studies. Study results were tabulated and levels of evidence assigned.
A total of 8 pharmacologic and 21 nonpharmacologic studies were identified that met the criteria. Of these 26 studies (some include both pharmacologic and nonpharmacologic interventions), only 1 pharmacologic RCT was identified (low-quality RCT producing level 2 evidence), in which midodrine was found to be effective in the management of OH after SCI. Functional electrical stimulation was one of the only nonpharmacologic interventions with some evidence (level 2) to support its utility.
Although a wide array of physical and pharmacologic measures are recommended for the management of OH in the general population, very few have been evaluated for use in SCI. Further research needs to quantify the efficacy of treatment for OH in subjects with SCI, especially of the many other pharmacologic interventions that have been shown to be effective in non-SCI conditions.
系统回顾脊髓损伤（SCI）患者体位性低血压（OH）管理的证据。
使用Medline、CINAHL、EMBASE和PsycInfo对原创文章、综述文章以及实践指南进行关键词文献检索，并对1950年至2008年7月检索到的文章进行手工检索，以确定评估当前用于OH治疗有效性的文献。
纳入随机对照试验（RCT）、前瞻性队列研究、病例对照研究、前后对照研究以及病例报告，这些研究评估了用于SCI患者OH管理的药物和非药物干预措施。
两名独立审阅者评估每项研究的质量，RCT使用物理治疗证据数据库评分，其他所有研究使用唐斯和布莱克量表。研究结果列表并分配证据等级。
共确定了8项药物研究和21项非药物研究符合标准。在这26项研究中（有些包括药物和非药物干预措施），仅确定了1项药物RCT（低质量RCT产生2级证据），其中发现米多君对SCI后OH的管理有效。功能性电刺激是少数有一些证据（2级）支持其效用的非药物干预措施之一。
虽然在一般人群中推荐了多种物理和药物措施来管理OH，但在SCI中的应用评估很少。需要进一步研究量化SCI患者OH治疗的疗效，特别是许多已证明在非SCI情况下有效的其他药物干预措施。
