James J. Peters Veterans Administration Medical Center, Bronx, NY, USA.
Arch Phys Med Rehabil. 2010 Sep;91(9):1429-35. doi: 10.1016/j.apmr.2010.06.017.
To determine the mean arterial pressure (MAP) and middle cerebral artery mean blood flow velocity (MFV) responses to 5 and 10mg midodrine during head-up tilt (HUT) in persons with tetraplegia.
Prospective dose-response trial.
James J. Peters Veterans Administration Medical Center.
Persons (N=10) with chronic tetraplegia (duration of injury=23+/-11 y).
A dose titration study was performed over 3 testing days: control (no drug), 5mg midodrine (5mg), or 10mg midodrine (10mg) during 30 minutes of baseline (predrug/no drug), 30 minutes of supine rest postdrug/no drug, 15 minutes of progressive HUT (5 minutes at 15 degrees , 25 degrees , 35 degrees ), and 45 minutes of 45 degrees HUT.
MAP and MFV response to midodrine supine and during HUT.
Ten milligrams of midodrine significantly increased MAP while supine and during the HUT maneuver. Of note, the mean increase in MAP during HUT with 10mg was a result of a robust effect in 2 persons, with minimal change in the remaining 8 study subjects. The reduction in cerebral MFV during HUT was attenuated with 10mg.
These findings suggest that midodrine 10mg may be efficacious for treatment of hypotension and orthostatic hypotension in select persons with tetraplegia. Although midodrine is routinely prescribed to treat orthostatic hypotension, the results of our work suggests limited efficacy of this agent, but additional studies in a larger sample of subjects with spinal cord injury should be performed.
确定在头高位倾斜（HUT）期间，5mg 和 10mg 米多君对四肢瘫痪患者的平均动脉压（MAP）和大脑中动脉平均血流速度（MFV）的影响。
前瞻性剂量反应试验。
詹姆斯·J·彼得斯退伍军人事务医疗中心。
10 名患有慢性四肢瘫痪的患者（损伤持续时间=23+/-11 年）。
在 3 个测试日进行了剂量滴定研究：对照（无药物）、5mg 米多君（5mg）或 10mg 米多君（10mg），在 30 分钟的基线（预药物/无药物）、30 分钟的仰卧休息后药物/无药物、15 分钟的逐渐 HUT（5 分钟在 15 度、25 度、35 度）和 45 分钟的 45 度 HUT。
米多君仰卧和 HUT 时的 MAP 和 MFV 反应。
10mg 米多君在仰卧和 HUT 操作时显著增加了 MAP。值得注意的是，10mg 在 HUT 期间 MAP 的平均增加是由于 2 人的强烈作用，而其余 8 名研究对象的变化最小。在 HUT 期间，脑 MFV 的减少得到了缓解。
这些发现表明，米多君 10mg 可能对治疗选择的四肢瘫痪患者的低血压和直立性低血压有效。尽管米多君通常被开处方用于治疗直立性低血压，但我们工作的结果表明该药物的疗效有限，但应该在更大的脊髓损伤患者样本中进行进一步的研究。
