Walker J, Shephard R J
Lyndhurst Hospital, School of Physical and Health Education.
Arch Phys Med Rehabil. 1993 Nov;74(11):1129-33.
Cardiac risk factors were evaluated in 48 persons (39 males, 9 females) with quadriplegia or paraplegia, resident in a specialized spinal injury hospital and seen 0.3 +/- 0.7 years after their spinal injury. The majority of the patients reported being extremely active physically prior to injury. Limited activity in the hospital involved the use of ergometers, pulleys, and weights; however, the majority of subjects expressed a wish for more exercise. Serum lipid profiles showed a relatively normal total cholesterol (mean 4.58 +/- 0.77 mmol/L), a very low high-density lipoprotein-cholesterol (0.91 +/- 0.27 mmol/L), a relatively normal low-density lipoprotein-cholesterol (2.86 +/- 0.68 mmol/L) and high triglycerides (1.89 +/- 0.88 mmol/L). Resting blood pressures were normal. The percentage of smokers (25%) was similar to the percentage of smokers in the general population, but many had quit smoking subsequent to hospitalization. Family histories and diet gave no evidence of increased cardiac risk. We conclude that individuals who sustain a spinal injury do not have a large inherent risk of cardiac events. In persons with paraplegia, cardiac problems develop mainly from the cumulative impact of reduced physical activity and a resulting adverse lipid profile. There may also be a reactive deterioration in other aspects of personal lifestyle, such as cigarette smoking after leaving the hospital. In high-level lesions, factors such as hypertension and a poor stroke volume with compensatory tachycardia may increase cardiac work rate during attempts at ambulation, further predisposing an individual to myocardial ischemia and cardiac arrest.
对居住在一家专门的脊髓损伤医院的48例四肢瘫痪或截瘫患者（39例男性，9例女性）进行了心脏危险因素评估，这些患者在脊髓损伤后0.3±0.7年接受了检查。大多数患者报告在受伤前身体活动极为活跃。在医院里有限的活动包括使用测力计、滑轮和重物；然而，大多数受试者表示希望进行更多锻炼。血清脂质谱显示总胆固醇相对正常（平均4.58±0.77 mmol/L），高密度脂蛋白胆固醇非常低（0.91±0.27 mmol/L），低密度脂蛋白胆固醇相对正常（2.86±0.68 mmol/L），甘油三酯高（1.89±0.88 mmol/L）。静息血压正常。吸烟者的比例（25%）与一般人群中的吸烟者比例相似，但许多人在住院后戒烟。家族史和饮食没有显示出心脏风险增加的迹象。我们得出结论，脊髓损伤患者发生心脏事件的内在风险不大。在截瘫患者中，心脏问题主要是由身体活动减少和由此导致的不良脂质谱的累积影响引起的。个人生活方式的其他方面也可能出现反应性恶化，比如出院后吸烟。在高位损伤中，诸如高血压和心搏量不佳伴代偿性心动过速等因素可能会在患者尝试行走时增加心脏工作负荷，进一步使个体易患心肌缺血和心脏骤停。
