Wecht Jill M, Wilson James, Previnaire Jean-Gabriel
1James J Peters VA Medical Center, Room 7A-13, 130 West Kingsbridge Road, Bronx, NY 10468 USA.
2Icahn School of Medicine, Mount Sinai, New York, NY USA.
Spinal Cord Ser Cases. 2017 Dec 6;3:17087. doi: 10.1038/s41394-017-0021-z. eCollection 2017.
Spinal cord injury (SCI) creates a complex and unique syndrome of medical issues related to disruption of somatic and autonomic pathways. Among these impaired control of blood pressure (BP) can significantly impede patients' activities of daily living. The International Standards for the Assessment of Autonomic Function after SCI (ISAFSCI) is used to document the impact of SCI on resting BP (abnormal if below 90 mmHg) and the presence or absence of orthostatic hypotension (OH), defined as a symptomatic or asymptomatic decrease in BP (>/=20/10 mmHg) upon moving to an upright position.
Case 1 documents the adverse influence of prescribed medications (antidepressants for neuropathic pain) on OH; case 2 describes the influence of bladder management on cardiovascular instability (autonomic dysreflexia and subsequent OH); case 3 describes the association between spasticity and OH; case 4 describes OH associated with a Valsalva maneuver.
Impaired control of BP can stem from a combination of medical issues and autonomic dysfunction in persons with SCI. Management strategies for OH will vary depending on the stage of the SCI, the root cause of the OH and other confounding medical conditions. Non-pharmacological treatment should be considered as a first line of intervention and consideration should be given to cessation of potentially contributory medications prior to implementing pharmaceutical interventions. The systematic use of ISAFSCI by clinicians is recommended to document BP irregularities and to describe the effects of treatment strategies aimed at improving BP control in the SCI population.
脊髓损伤（SCI）会引发一系列复杂且独特的医学问题综合征，这些问题与躯体和自主神经通路的中断有关。其中，血压（BP）控制受损会严重妨碍患者的日常生活活动。国际脊髓损伤后自主神经功能评估标准（ISAFSCI）用于记录脊髓损伤对静息血压的影响（若低于90mmHg则为异常）以及直立性低血压（OH）的有无，直立性低血压定义为体位改变为直立位时出现的有症状或无症状的血压下降（≥20/10mmHg）。
病例1记录了处方药物（用于治疗神经性疼痛的抗抑郁药）对直立性低血压的不良影响；病例2描述了膀胱管理对心血管不稳定（自主神经反射异常及随后的直立性低血压）的影响；病例3描述了痉挛与直立性低血压之间的关联；病例4描述了与瓦尔萨尔瓦动作相关的直立性低血压。
脊髓损伤患者血压控制受损可能源于多种医学问题和自主神经功能障碍。直立性低血压的管理策略将因脊髓损伤的阶段、直立性低血压的根本原因以及其他混杂的医学状况而有所不同。非药物治疗应被视为一线干预措施，在实施药物干预之前应考虑停用可能有影响的药物。建议临床医生系统地使用ISAFSCI来记录血压异常情况，并描述旨在改善脊髓损伤人群血压控制的治疗策略的效果。
