Wecht Jill M, Weir Joseph P, Bauman William A
a VA RR&D Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VAMC , Bronx , NY , USA.
c Department of Medicine , The Icahn School of Medicine at Mount Sinai , New York , NY , USA.
J Spinal Cord Med. 2017 Mar;40(2):159-169. doi: 10.1080/10790268.2015.1135556. Epub 2016 Feb 17.
Due to interruption of cardiovascular autonomic control unstable blood pressure (BP) is common in individuals with spinal cord injury (SCI) above the sixth thoracic vertebral level. The impact of unstable BP on cerebral blood flow (CBF) is not well appreciated, but symptoms associated with altered cerebral perfusion are reported, which can negatively impact daily life activities.
We measured seated BP and CBF in participants with SCI and able-bodied (AB) controls on three laboratory visits to determine the inter-day reliability (intraclass correlation coefficient: ICC). BP was assessed at the finger using photoplethysmography and at the brachial artery with manual sphygmomanometry. CBF velocities (CBFv) were assessed at the middle cerebral artery using transcranial Doppler (TCD) ultrasound.
Data were collected in 15 participants with chronic SCI (C3-T4) and 10 AB controls, the groups did not differ for age, height, weight or BMI; however, brachial BP (P < 0.001), finger BP (P < 0.01) and CBFv (P < 0.05) were significantly lower in the SCI group compared to the controls. The inter-day ICC for brachial BP ranged from 0.51 to 0.79, whereas the ICC for finger BP was not as high (0.17 to 0.47). The inter-day ICC for CBFv ranged from 0.45 to 0.96, indicating fair to substantial reliability.
These data indicate good inter-day reliability of brachial BP and TCD recording of CBFv; however, the assessment of finger BP appears to be somewhat less reliable. In addition, these data confirm reduced resting CBFv in association with hypotension in individuals with SCI compared to matched controls with low BP.
由于心血管自主控制功能中断，第六胸椎水平以上脊髓损伤（SCI）患者中血压（BP）不稳定很常见。血压不稳定对脑血流量（CBF）的影响尚未得到充分认识，但有报告称存在与脑灌注改变相关的症状，这会对日常生活活动产生负面影响。
我们在三次实验室访视中测量了脊髓损伤患者和健全（AB）对照者的坐位血压和脑血流量，以确定日间可靠性（组内相关系数：ICC）。使用光电容积脉搏波描记法在手指处评估血压，并用手动血压计在肱动脉处评估血压。使用经颅多普勒（TCD）超声在大脑中动脉处评估脑血流速度（CBFv）。
收集了15名慢性脊髓损伤（C3-T4）患者和10名健全对照者的数据，两组在年龄、身高、体重或体重指数方面无差异；然而，与对照组相比，脊髓损伤组的肱动脉血压（P < 0.001）、手指血压（P < 0.01）和脑血流速度（P < 0.05）显著较低。肱动脉血压的日间ICC范围为0.51至0.79，而手指血压的ICC则没那么高（0.17至0.47）。脑血流速度的日间ICC范围为0.45至0.96，表明可靠性为中等至较高。
这些数据表明肱动脉血压和脑血流速度的TCD记录具有良好的日间可靠性；然而，手指血压的评估似乎不太可靠。此外，这些数据证实，与血压较低的匹配对照组相比，脊髓损伤患者静息时脑血流速度降低与低血压有关。
