Study on pathophysiological mechanisms responsible for the subset of orthostatic dysregulation and new integrative treatments.

研究直立性失调的病理生理机制和新的综合治疗。

基本信息

批准号：
14570782
负责人：
TANAKA Hidetaka
金额：
$ 2.11万
依托单位：
Osaka Medical College
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2002
资助国家：
日本
起止时间：
2002 至 2005
项目状态：
已结题

项目摘要

We determined the criteria of four subsets or orthostatic dysregulation ; instantaneous orthostatic hypotension (INOH), postural tachycardia syndrome (POTS), delayed orthostatic hypotension and neurally-mediated syncope (NMS). INOH, sudden drop of blood pressure associated with active standing, is caused by blurred activation of sympathetic activation in the arteriolar vessels. This also involves the excessive pooling of blood in the lower part of the body, thus causing tachycardia during standing. POTS, showing tachycardia >= 115 during standing, is associated with augmentation of sympathetic activity of the heart. The loss of plasma volume or reduction of circulating blood during orthostatic stress is also involved in POTS. NMS is characterized with sudden reduction of blood pressure associated with loss of consciousness with or without cardioinhibitory mechanisms. This episode sometimes develops after severe increase in heart rate during standing in children with INOH and POTS. Thes … More e types of orthostatic intolerance were found to cause impairment of cerebral circulation only during upright posture in about half of the patients, resulting in various disabling symptoms, such as orthostatic dizziness, strong fatigue, fainting and lowering brain function including cognition and thinking. These disadvantages reduce quality of life in patients, thus causing psychological distress as well. There has been one report on the relation between orthostatic intolerance and gene mutation, although we did not find such a patient during the research period. New treatments have been also developed in this study from the biological and psychosocial aspect ; non-pharmacological treatments, medication and psychosocial support. The first alternative includes the repair of circadian rhythm, exercise training with adequate degree and sodium / water intake. We also invented an inflatable abdominal bandage which inhibits blood pooling in the lower part of the body. Regarding medication midodline was found as a most effective and a safe drug for INOH and POTS. We established the comprehensive support network system for patients with orthostatic dysregulation and school absenteeism from the bio-psycho-socio-ethical aspect. In this system, we incorporated a new occupational stuff, named "mental associates", who is usually an university postgraduate is expected to visit home of a child with school absenteeism and psychosomatic diseases for the purpose of metal support, tutoring and rehabilitation in society, under the control of medical specialists. A trained mental associate carried out his task according to the elaborated original program. We have experienced 17 cases. A mental associate performed a task once a week for 90 minutes including going out home and step-by-step tutoring, resulting recovery of emotional steadiness, decision-making and sociality. Less

我们确定了四肢或直立性失调的标准；瞬时直立性低血压（INOH）、体位性心动过速综合征（POTS）、迟发性直立性低血压和神经介导性晕厥亚型（NMS），即与主动站立相关的血压突然下降。由小动脉血管交感神经激活模糊引起，这也涉及身体下部的血液过度聚集，从而导致心动过速。站立时出现心动过速 >= 115，与心脏交感神经活动增强有关。 NMS 的特征还包括立位应激期间血浆容量的减少或循环血液的减少。在患有 INOH 和 POTS 的儿童中，这种情况有时会在站立时心率严重增加后发生，与意识丧失相关。约半数患者仅在直立姿势时脑循环受到影响，从而出现各种失能症状，如直立性头晕、强烈疲劳、昏厥以及认知和思维等大脑功能下降，这些不利因素降低了患者的生活质量，从而导致心理问题。也有一篇关于直立不耐受与基因突变之间关系的报道，尽管我们在研究期间没有发现这样的患者，但在这项研究中也从生物学和社会心理方面开发了新的治疗方法；非药物治疗、药物心理和社会支持包括修复昼夜节律、适当的运动训练和钠/水的摄入。我们还发明了一种可抑制下半身血液淤积的充气腹部绷带。关于药物治疗，米多林被认为是对 INOH 和 POTS 来说最有效、最安全的药物。在这个系统中，我们纳入了一个新的职业人员，名为“心理助理”，他们通常是一名大学研究生，预计会拜访患有学校缺勤和心身疾病的孩子的家，以达到社会上的金属支持、辅导和康复的目的。训练有素的心理助理按照详细的原始程序执行任务我们经历了17个案例，心理助理每周执行一次任务，每次90分钟，包括回家和逐步辅导。，从而恢复情绪稳定性、决策力和社交性较低。