青少年即时直立性低血压患者主动站立试验期间的脑自动调节。

Cerebral Autoregulation During Active Standing Test in Juvenile Patients with Instantaneous Orthostatic Hypotension.

机构信息

Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.

Center for Institutional Research and Medical Education, Nihon University School of Medicine, Tokyo, Japan.

出版信息

Adv Exp Med Biol. 2020;1232:77-83. doi: 10.1007/978-3-030-34461-0_11.

DOI:10.1007/978-3-030-34461-0_11

PMID:31893397

Abstract

Instantaneous orthostatic hypotension (INOH) is one of the main types of orthostatic dysregulation in children and adolescents. In patients with INOH arterial pressure drops considerably after active standing and is slow to recover. We investigated changes in cerebral oxygenation in the bilateral prefrontal cortex during an active standing test in juvenile INOH patients to evaluate changes in cerebral oxygen metabolism. We enrolled 82 INOH patients (mean age 13.8 ± 2.2 years, 52 mild and 30 severe patients) at Nihon University Itabashi Hospital from October 2013 to April 2018. We measured cerebral oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin levels in the bilateral prefrontal cortex using near-infrared spectroscopy during an active standing test. In severe INOH patients, cerebral oxygenation of the right prefrontal cortex remained constant when blood pressure dropped; however, de-oxy-Hb significantly increased. These findings confirm that there is asymmetrical autoregulation between the right and left prefrontal cortex.

摘要

即刻性直立性低血压（INOH）是儿童和青少年直立调节障碍的主要类型之一。在 INOH 患者中，动脉血压在主动站立后会显著下降，且恢复缓慢。我们通过主动站立测试，研究了青少年 INOH 患者双侧前额叶皮质的脑氧合变化，以评估脑氧代谢的变化。我们于 2013 年 10 月至 2018 年 4 月在日本大学板桥医院招募了 82 名 INOH 患者（平均年龄 13.8±2.2 岁，轻度 52 例，重度 30 例）。我们使用近红外光谱技术在主动站立测试期间测量了双侧前额叶皮质的氧合血红蛋白、去氧血红蛋白和总血红蛋白水平。在重度 INOH 患者中，当血压下降时，右侧前额叶皮质的脑氧合保持不变；然而，去氧-Hb 显著增加。这些发现证实了左右前额叶皮质之间存在不对称的自动调节。