Gilbert V E
Department of Internal Medicine, University of Tennessee Memorial Hospital, Knoxville.
South Med J. 1993 Sep;86(9):1028-32.
Hypotension (systolic blood pressure less than 90 mm Hg) was induced immediately in 21 acutely ill normotensive patients when they were raised from a supine to an upright position. Systolic blood pressure declined to 80 mm Hg or lower in all patients and to 65 mm Hg or lower in 10 patients when they assumed an upright posture. Immediate orthostatic hypotension observed in 9 patients suggested hypovolemia, which was promptly corrected by rapid infusion of large volumes of normal saline and/or albumin. Orthostatic hypotension was of diagnostic aid in 16 patients, including 4 with infections (pelvic inflammatory disease, occult septic shock, legionnaires' disease, Rocky Mountain spotted fever), 3 with adrenal insufficiency, 2 with acute myocardial infarction, 1 with hypoglycemia, 2 with severe cardiac valvular obstruction, and 4 with inappropriate drug use (enalapril or trazodone). These findings suggest that immediate orthostatic hypotension in acutely ill patients is a physical sign that might have valuable diagnostic and therapeutic implications.
21名急性病血压正常的患者从仰卧位变为直立位后，立即出现了低血压（收缩压低于90毫米汞柱）。所有患者的收缩压均降至80毫米汞柱或更低，10名患者在直立姿势时收缩压降至65毫米汞柱或更低。9名患者出现的即时体位性低血压提示血容量不足，通过快速输注大量生理盐水和/或白蛋白迅速得到纠正。体位性低血压对16名患者的诊断有帮助，其中包括4名感染患者（盆腔炎、隐匿性感染性休克、军团病、落基山斑疹热）、3名肾上腺功能不全患者、2名急性心肌梗死患者、1名低血糖患者、2名严重心脏瓣膜阻塞患者以及4名药物使用不当患者（依那普利或曲唑酮）。这些发现表明，急性病患者的即时体位性低血压是一种体征，可能具有重要的诊断和治疗意义。
