Ropper A H, Wijdicks E F
Neurological/Neurosurgical Intensive Care Unit, Massachusetts General Hospital, Boston 02114.
Arch Neurol. 1990 Jun;47(6):706-8. doi: 10.1001/archneur.1990.00530060120029.
A 76-year-old man with severe Guillain-Barré syndrome had extremes of hypotension alternating with hypertension. His blood pressure paralleled both systemic vascular resistance and cardiac output. Heart rate, rather than stroke volume, was the major determinant of cardiac output over a wide range of blood pressures. It was at times invariant for several hours and was unresponsive to carotid massage or respiratory cycles, but slowed slightly with each episode of hypotension. Trend monitoring indicated that hypotension preceded reductions in pulmonary artery diastolic pressure. These findings suggest that hypotension resulted from a vasodepressor response with a vagotomized heart and that hypertension was the result of increased sympathetic activity. Both extremes were caused by parallel changes in vascular resistance and heart rate. Dysfunction of baroreflex buffering may have accounted for the rapid swings in pressure.
一名患有严重吉兰-巴雷综合征的76岁男性血压波动极大，出现低血压与高血压交替的情况。他的血压与全身血管阻力和心输出量呈平行关系。在较宽的血压范围内，心率而非每搏输出量是心输出量的主要决定因素。心率有时会在数小时内保持不变，对颈动脉按摩或呼吸周期无反应，但每次低血压发作时会略有减慢。趋势监测表明，低血压先于肺动脉舒张压降低出现。这些发现提示，低血压是由于心脏迷走神经切断后血管减压反应所致，而高血压是交感神经活动增强的结果。血压的两个极端情况均由血管阻力和心率的平行变化引起。压力感受器反射缓冲功能障碍可能是导致血压快速波动的原因。
