Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Eur J Neurol. 2010 Nov;17(11):1370-6. doi: 10.1111/j.1468-1331.2010.03030.x.
Rapid water ingestion improves orthostatic intolerance (OI) in multiple system atrophy (MSA) and postural tachycardia syndrome (PoTS). We compared haemodynamic changes after water and clear soup intake, the latter being a common treatment strategy for OI in daily practice.
Seven MSA and seven PoTS patients underwent head-up tilt (HUT) without fluid intake and 30 min after drinking 450 ml of water and clear soup, respectively. All patients suffered from moderate to severe OI because of neurogenic orthostatic hypotension (OH) and excessive orthostatic heart rate (HR) increase, respectively. Beat-to-beat cardiovascular indices were measured non-invasively.
In MSA, HUT had to be terminated prematurely in 2/7 patients after water, but in 6/7 after clear soup. At 3 min of HUT, there was an increase in blood pressure of 15.7(8.2)/8.3(2.3) mmHg after water, but a decrease of 11.6(18.9)/8.1(9.2) mmHg after clear soup (P < 0.05). In PoTS, HUT could always be completed for 10 min, but OI subjectively improved after both water and clear soup. The attenuation of excessive orthostatic HR increase did not differ significantly after water and clear soup drinking.
In MSA, clear soup cannot substitute water for eliciting a pressor effect, but even worsens OI after rapid ingestion. In PoTS, acute water and clear soup intake both result in improvement of OI. These findings cannot solely be explained by difference in osmolarity but may reflect some degree of superimposed postprandial hypotension in widespread autonomic failure in MSA compared to the mild and limited autonomic dysfunction in PoTS.
快速饮水可改善多系统萎缩（MSA）和姿势性心动过速综合征（PoTS）患者的直立不耐受（OI）。我们比较了饮水和清汤摄入后的血液动力学变化，后者是日常实践中治疗 OI 的常用策略。
7 名 MSA 和 7 名 PoTS 患者分别在未饮水和饮水 450ml 后 30 分钟进行头高位倾斜（HUT）。所有患者均因神经源性直立性低血压（OH）和过度的直立性心率（HR）增加而患有中重度 OI。通过无创方式测量心动周期的心血管指数。
在 MSA 中，2/7 名患者在饮水后 HUT 提前终止，但在 6/7 名患者在饮用清汤后提前终止。在 HUT 的第 3 分钟，饮水后血压升高 15.7(8.2)/8.3(2.3)mmHg，但饮用清汤后血压下降 11.6(18.9)/8.1(9.2)mmHg（P<0.05）。在 PoTS 中，HUT 总能完成 10 分钟，但饮水和清汤后主观上均能改善 OI。饮水和清汤后，过度的直立性 HR 增加的衰减没有明显差异。
在 MSA 中，清汤不能代替水引起升压作用，但快速摄入后甚至会使 OI 恶化。在 PoTS 中，急性饮水和清汤摄入均可改善 OI。这些发现不能仅用渗透压的差异来解释，而可能反映了与 PoTS 相比，广泛自主神经衰竭患者餐后低血压的程度有所重叠。
