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血压短期变异性:下体负压和长时间卧床休息的影响。

Short-term variability of blood pressure: effects of lower-body negative pressure and long-duration bed rest.

机构信息

Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy.

出版信息

Am J Physiol Regul Integr Comp Physiol. 2012 Jul 1;303(1):R77-85. doi: 10.1152/ajpregu.00050.2012. Epub 2012 May 2.

Abstract

Mild lower-body negative pressure (LBNP) has been utilized to selectively unload cardiopulmonary baroreceptors, but there is evidence that arterial baroreceptors can be transiently unloaded after the onset of mild LBNP. In this paper, a black box mathematical model for the prediction of diastolic blood pressure (DBP) variability from multiple inputs (systolic blood pressure, R-R interval duration, and central venous pressure) was applied to interpret the dynamics of blood pressure maintenance under the challenge of LBNP and in long-duration, head-down bed rest (HDBR). Hemodynamic recordings from seven participants in the WISE (Women's International Space Simulation for Exploration) Study collected during an experiment of incremental LBNP (-10 mmHg, -20 mmHg, -30 mmHg) were analyzed before and on day 50 of a 60-day-long HDBR campaign. Autoregressive spectral analysis focused on low-frequency (LF, ~0.1 Hz) oscillations of DBP, which are related to fluctuations in vascular resistance due to sympathetic and baroreflex regulation of vasomotor tone. The arterial baroreflex-related component explained 49 ± 13% of LF variability of DBP in spontaneous conditions, and 89 ± 9% (P < 0.05) on day 50 of HDBR, while the cardiopulmonary baroreflex component explained 17 ± 9% and 12 ± 4%, respectively. The arterial baroreflex-related variability was significantly increased in bed rest also for LBNP equal to -20 and -30 mmHg. The proposed technique provided a model interpretation of the proportional effect of arterial baroreflex vs. cardiopulmonary baroreflex-mediated components of blood pressure control and showed that arterial baroreflex was the main player in the mediation of DBP variability. Data during bed rest suggested that cardiopulmonary baroreflex-related effects are blunted and that blood pressure maintenance in the presence of an orthostatic stimulus relies mostly on arterial control.

摘要

轻度下肢负压(LBNP)已被用于选择性地卸载心肺压力感受器,但有证据表明,轻度 LBNP 后动脉压力感受器可以暂时卸载。在本文中,应用一个黑盒数学模型来预测舒张期血压(DBP)的变异性,模型输入为多个参数(收缩压、R-R 间隔时间和中心静脉压),该模型用于解释在 LBNP 挑战和长时间的头低位卧床(HDBR)期间血压维持的动力学。WISE(女性探索国际空间模拟)研究中的 7 名参与者在一项递增 LBNP(-10mmHg、-20mmHg、-30mmHg)实验中收集的血流动力学记录,在 HDBR 试验的第 50 天之前和之后进行了分析。自回归谱分析侧重于 DBP 的低频(LF,~0.1Hz)振荡,LF 与血管阻力的波动有关,这是由于交感神经和压力反射对血管紧张度的调节。在自然条件下,动脉压力反射相关成分解释了 DBP 的 LF 变异性的 49±13%,而在 HDBR 的第 50 天,这一比例上升到 89±9%(P<0.05),而心肺压力反射成分分别解释了 17±9%和 12±4%。在卧床休息期间,即使施加的 LBNP 为-20mmHg 和-30mmHg,动脉压力反射相关的变异性也显著增加。该技术提供了一种模型解释,说明了动脉压力反射和心肺压力反射介导的血压控制成分之间的比例效应,并表明动脉压力反射是介导 DBP 变异性的主要因素。卧床休息期间的数据表明,心肺压力反射相关的效应减弱,在存在直立刺激的情况下,血压维持主要依赖于动脉控制。

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