Braune S, Schulte-Mönting J, Schwerbrock S, Lücking C H
Department of Neurology, University of Freiburg, Germany.
J Auton Nerv Syst. 1996 Sep 12;60(3):103-7. doi: 10.1016/0165-1838(96)00018-5.
Little information is available on the methodological and physiological limits of repeatedly testing changes of blood pressure (BP) and heart rate (HR) during autonomic testing. The retest variation determines the value of follow-up investigations for the assessment of the natural course of patients with autonomic failure or the efficacy of treatment. 34 healthy volunteers between 18 and 85 years of age were tested twice within a mean period of one year (75-637 days). BP and HR were measured continuously with a Finapress device during active change of posture, passive tilt, deep breathing, Valsalva manoeuvre, isometric muscle exercise and mental arithmetic. The differences to baseline resting values before each manoeuvre were analysed. Although differences between the two occasions were comparatively small with mostly 1-7 mmHg for BP and 0.3-4 bpm for HR, the high standard deviations did not allow the calculation of useful normal ranges, as they would exceed meaningful (patho-) physiological changes over time. Therefore, a single repetition of a series of standard autonomic function tests did not appear to be suitable for follow-up observations. The calculation of the components of the coefficients of variation showed a predominance of the within variance as the cause of the poor reproducibility for the BP measurements, while changes in HR were more influenced by the between variation. The combination of the selection of some tests with a high between variance and the reduction of the within variance by performing 4, 5 retest runs can increase the reliability of standard autonomic function tests regarding follow-up assessments.
关于自主神经功能测试期间反复测量血压（BP）和心率（HR）变化的方法学和生理学限制，目前可用信息较少。复测变异决定了随访研究对于评估自主神经功能衰竭患者自然病程或治疗效果的价值。34名年龄在18至85岁之间的健康志愿者在平均一年（75 - 637天）的时间内接受了两次测试。在姿势主动改变、被动倾斜、深呼吸、瓦尔萨尔瓦动作、等长肌肉运动和心算过程中，使用Finapress设备连续测量BP和HR。分析每次动作前与基线静息值的差异。尽管两次测量之间的差异相对较小，BP大多为1 - 7 mmHg，HR为0.3 - 4次/分钟，但高标准差不允许计算有用的正常范围，因为随着时间推移，这些标准差会超过有意义的（病理）生理变化。因此，一系列标准自主神经功能测试的单次重复似乎不适用于随访观察。变异系数各成分的计算表明，对于BP测量，内部方差占主导地位，这是重复性差的原因，而HR变化受个体间方差的影响更大。选择一些个体间方差较高的测试，并通过进行4、5次复测来减少内部方差，这种组合可以提高标准自主神经功能测试在随访评估方面的可靠性。
