Bouvette C M, McPhee B R, Opfer-Gehrking T L, Low P A
Department of Physical Medicine and Rehabilitation, Mayo Clinic Rochester, Minnesota 55905, USA.
Mayo Clin Proc. 1996 Sep;71(9):847-53. doi: 10.4065/71.9.847.
To evaluate the efficacy of various physical countermaneuvers in reducing orthostatic hypotension and its associated symptoms and to assess the efficacy of biofeedback training in enhancing the effectiveness of physical countermaneuvers.
In nine study subjects with neurogenic orthostatic hypotension, four training sessions on physical countermaneuvers were performed after tilt-up, three with visual feedback on the effect of physical countermaneuvers on blood pressure and other cardiovascular variables. Blood pressure change and orthostatic symptoms during tilt-up were determined, as were the changes in total peripheral resistance, stroke index, and heart rate.
The five female and four male patients had a mean age of 53 years and a mean duration of symptoms of 4.2 years. On an orthostatic symptom scale of 0 to 10, these patients had a mean symptom score of 7.3. The increment in systolic blood pressure was better for some maneuvers (such as leg crossing and a combination) than others (such as neck flexion and abdominal contraction). Three patterns of responses to biofeedback were found. Simple maneuvers such as squatting did not improve with training; visual feedback was needed for maneuvers such as thigh contraction, and performance declined without biofeedback; the third pattern, seen in maneuvers such as leg crossing, showed continued improvement with training, even without biofeedback. A survey at 3 to 4 months after training revealed continued use of physical maneuvers (3.8 +/- 3.1 per day), increased standing time with each episode of presyncopal symptoms (8.3 +/- 5.8 minutes), and continued global symptomatic improvement. Total peripheral resistance, but not heart rate or stroke index, showed significant regression with blood pressure improvement.
Physical countermaneuvers are efficacious in reducing orthostatic hypotension, can be augmented by use of biofeedback, and may significantly improve the functional outcome. The major mechanism of improvement is an increase in total peripheral resistance, presumably by reducing the vascular capacitance.
评估各种身体对抗动作在减轻直立性低血压及其相关症状方面的疗效，并评估生物反馈训练在增强身体对抗动作有效性方面的疗效。
对9名患有神经源性直立性低血压的研究对象，在倾斜试验后进行了4次身体对抗动作训练，其中3次训练有关于身体对抗动作对血压及其他心血管变量影响的视觉反馈。测定了倾斜试验期间的血压变化和直立症状，以及总外周阻力、每搏指数和心率的变化。
5名女性和4名男性患者的平均年龄为53岁，症状平均持续时间为4.2年。在0至10的直立症状量表上，这些患者的平均症状评分为7.3。某些动作（如交叉双腿及联合动作）的收缩压升高效果优于其他动作（如颈部屈曲和腹部收缩）。发现了三种对生物反馈的反应模式。诸如蹲坐等简单动作训练后并无改善；诸如大腿收缩等动作需要视觉反馈，无生物反馈时表现会下降；第三种模式见于诸如交叉双腿等动作，即使无生物反馈，训练后仍持续改善。训练后3至4个月的一项调查显示，身体动作仍在持续使用（每天3.8±3.1次），每次前驱晕厥症状发作时的站立时间增加（8.3±5.8分钟），整体症状持续改善。随着血压改善，总外周阻力显著下降，但心率和每搏指数未下降。
身体对抗动作在减轻直立性低血压方面有效，可通过使用生物反馈增强效果，并可能显著改善功能结局。改善的主要机制是总外周阻力增加，推测是通过减少血管容量实现的。
