Snapper Howard, Cheshire William P
Department of Cardiology, Wellstar Healthcare System, Marietta, GA 30060, USA.
Division of Autonomic Disorders, Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA.
Auton Neurosci. 2022 Mar;238:102951. doi: 10.1016/j.autneu.2022.102951. Epub 2022 Jan 31.
Hydration with water and salt is the mainstay of treatment for autonomic nervous system disorders that impair orthostatic tolerance. The goal is to expand intravascular volume to compensate for the downward displacement of blood volume that occurs when standing and thereby sustain cerebral perfusion and restore quality of life. Despite strong consensus recommendations for salt supplementation as standard treatment of these disorders, published evidence of benefit is relatively weak, and no randomized clinical trials have occurred. This review summarizes the physiological rationale for hydration and evaluates the literature on oral and intravenous hydration in the treatment of neurogenic orthostatic hypotension, postural tachycardia syndrome, and recurrent vasovagal syncope. We conclude that oral salt replacement is indicated for treatment of neurogenic orthostatic hypotension because these patients have excessive renal sodium excretion, and for treatment of chronic orthostatic intolerance because these patients are often hypovolemic. As not all patients are able to tolerate sufficient oral hydration, there is also a role for intravenous volume-loading in severe cases of postural tachycardia syndrome. We offer guidance, based on review of the literature and the clinical judgment of a cardiologist and neurologist with experience treating autonomic disorders, regarding the option of ongoing intravenous hydration for treatment of severe, refractory cases of postural tachycardia syndrome.
通过补充水和盐进行补液是治疗损害直立耐受能力的自主神经系统疾病的主要方法。目标是扩充血管内容量，以补偿站立时发生的血容量向下移位，从而维持脑灌注并恢复生活质量。尽管对于补充盐分作为这些疾病的标准治疗方法已达成强烈的共识性建议，但已发表的获益证据相对薄弱，且尚未进行随机临床试验。本综述总结了补液的生理原理，并评估了关于口服和静脉补液治疗神经源性直立性低血压、体位性心动过速综合征及复发性血管迷走性晕厥的文献。我们得出结论，口服补盐适用于治疗神经源性直立性低血压，因为这些患者肾钠排泄过多；也适用于治疗慢性直立不耐受，因为这些患者常存在血容量不足。由于并非所有患者都能耐受足够的口服补液，在体位性心动过速综合征的严重病例中，静脉扩容也有作用。基于对文献的综述以及一位有自主神经疾病治疗经验的心脏病专家和神经科医生的临床判断，我们针对持续静脉补液治疗严重难治性体位性心动过速综合征的选择提供指导。
