Aslan Sevda C, Legg Ditterline Bonnie E, Park Michael C, Angeli Claudia A, Rejc Enrico, Chen Yangsheng, Ovechkin Alexander V, Krassioukov Andrei, Harkema Susan J
Department of Neurological Surgery, University of Louisville, Louisville, KY, United States.
Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.
Front Physiol. 2018 May 18;9:565. doi: 10.3389/fphys.2018.00565. eCollection 2018.
Disruption of motor and autonomic pathways induced by spinal cord injury (SCI) often leads to persistent low arterial blood pressure and orthostatic intolerance. Spinal cord epidural stimulation (scES) has been shown to enable independent standing and voluntary movement in individuals with clinically motor complete SCI. In this study, we addressed whether scES configured to activate motor lumbosacral networks can also modulate arterial blood pressure by assessing continuous, beat-by-beat blood pressure and lower extremity electromyography during supine and standing in seven individuals with C5-T4 SCI. In three research participants with arterial hypotension, orthostatic intolerance, and low levels of circulating catecholamines (group 1), scES applied while supine and standing resulted in increased arterial blood pressure. In four research participants without evidence of arterial hypotension or orthostatic intolerance and normative circulating catecholamines (group 2), scES did not induce significant increases in arterial blood pressure. During scES, there were no significant differences in electromyographic (EMG) activity between group 1 and group 2. In group 1, during standing assisted by scES, blood pressure was maintained at 119/72 ± 7/14 mmHg (mean ± SD) compared with 70/45 ± 5/7 mmHg without scES. In group 2 there were no arterial blood pressure changes during standing with or without scES. These findings demonstrate that scES configured to facilitate motor function can acutely increase arterial blood pressure in individuals with SCI-induced cardiovascular deficits.
脊髓损伤（SCI）导致的运动和自主神经通路中断常引发持续性低血压和体位性不耐受。脊髓硬膜外刺激（scES）已被证明能使临床运动完全性SCI患者实现独立站立和自主运动。在本研究中，我们通过评估7例C5 - T4 SCI患者仰卧位和站立位时的连续逐搏血压及下肢肌电图，探讨配置为激活腰骶部运动网络的scES是否也能调节动脉血压。在3例患有动脉低血压、体位性不耐受且循环儿茶酚胺水平较低的研究参与者（第1组）中，仰卧位和站立位时应用scES可使动脉血压升高。在4例无动脉低血压或体位性不耐受证据且循环儿茶酚胺水平正常的研究参与者（第2组）中，scES未引起动脉血压显著升高。在scES期间，第1组和第2组之间的肌电图（EMG）活动无显著差异。在第1组中，在scES辅助站立期间，血压维持在119/72 ± 7/14 mmHg（均值±标准差），而无scES时为70/45 ± 5/7 mmHg。在第2组中，无论有无scES，站立期间动脉血压均无变化。这些发现表明，配置为促进运动功能的scES可使患有SCI所致心血管功能障碍的个体的动脉血压急剧升高。
