DETERMINATION OF A NEW CRITERIA FOR ORTHOSTATIC DYSREGUATION

确定直立性失调的新标准

基本信息

批准号：
07670917
负责人：
TANAKA Hidetaka
金额：
$ 1.15万
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：
1995
资助国家：
日本
起止时间：
1995 至 1996
项目状态：
已结题

项目摘要

We determined the criteria for instantaneous orthostatic hypotension (INOH), a typical form of orthostatic dysregulation, from the reference data of 173 healthy children, aged 6 to 18 years. Also reported were clinical characteristics, circulatory and catecholamine responses to postural change in 44 children and young adults with instantaneous orthostatic hypotension (INOH) compared with 73 age matched controls. The criteria for INOH was as follows : group I (mild type), a 60% or greater decrease in mean blood pressure during the initial phase of standing, or blood pressure recovery time of more than 25 sec evaluated by a non-invasive finger arterial pressure monitoring system ; group II (severe type), prolonged reduction in systolic arterial pressure of more than 15% during the later stage of standing in addition to the criteria for group I.Sensitivity and specificity of this criteria were as high as 100% and 90.4%, respectively. Group I and group II showed significantly more pronounc … More ed reduction in BP) than normal controls at the initial drop (% reduction for systolic BP : -53+-12, -50+-6 vs.-32+-16, respectively, p<0.001), one minute of standing (-6+-10, -24+-18 vs.6+-12, p<0.001) and five minute of standing (-5+13, -21+-11 vs.8+-9, p<0.05). Plasma noradrenaline responses to standing were significantly lower in group I and group II than in controls after one minute of standing (50+-63,33+-39 vs.99+-56 pg/ml, respevtively), and were kept lower in group II after five minutes (218+-122,115+-78 vs.193+-98 pg/ml, respectively). The physical complaints included chronic fatigue (91% of the patients), orthostatic dizziness (88%), weakness (84%), sleep disturbance (73%), syncope or near syncope (68%), headache (68%), loss of apprtite (57%), abdominal pain (55%). Among these complaints chronic fatigue, loss of appetite, orthostatic dizziness, syncope and morning tiredness were specific for INOH.These results suggest that mechanisms responsible for INOH may depend on reduced noradrenaline secretion during orthostatic stress, associated with centrally mediated sympathetic inhibition. The patients in group II seemed to have more decreased sympathetic activation and thus more impaired quality of life than those in group I including school absenteeism. INOH is an important pathological condition in children with complaints of orthostatic intolerance and chronic fatigue. This can be identified when using a non-invasive beat-to-beat continuous blood pressure monitoring system. Less

我们根据 173 名 6 至 18 岁健康儿童的参考数据确定了瞬时直立性低血压 (INOH) 的标准，这是一种典型的直立性失调，还报告了 44 名儿童的临床特征、循环和儿茶酚胺对姿势变化的反应。患有瞬时直立性低血压 (INOH) 的年轻人与 73 名年龄匹配的对照者进行比较。 INOH 的标准如下：I 组（轻度型），站立初始阶段平均血压下降 60% 或以上，或通过无创手指动脉压监测系统评估血压恢复时间超过 25 秒，II 组（严重型），收缩压长期下降；除第一组标准外，站立后期动脉压超过15%。该标准的敏感性和特异性分别高达100%和90.4%。 I 组和 II 组在初始下降时显示出比正常对照更显着的血压降低（收缩压降低百分比：分别为 -53+-12、-50+-6 与 -32+-16， p<0.001)，站立一分钟 (-6+-10, -24+-18 vs.6+-12, p<0.001) 和站立五分钟 (-5+13, -21+-11 vs.8+-9，p<0.05 站立一分钟后，I 组和 II 组的血浆去甲肾上腺素反应显着低于对照组（50+-63，33+-39 vs.）。 .99+-56 pg/ml，分别），五分钟后第二组保持较低水平（218+-122,115+-78）身体不适包括慢性疲劳（91% 的患者）、直立性头晕（88%）、虚弱（84%）、睡眠障碍（73%）、晕厥或近乎晕厥。这些症状包括晕厥（68%）、头痛（68%）、食欲不振（57%）、腹痛（55%）。晕厥和疲倦是 INOH 所特有的。这些结果表明，导致 INOH 的早晨机制可能取决于直立应激期间去甲肾上腺素分泌的减少，这与中枢介导的交感神经抑制有关。第二组患者的交感神经激活似乎更加减少，因此受损更严重。生活质量高于第一组，包括缺勤，这是患有直立不耐受和慢性疲劳的儿童的一种重要病理状况，这可以在使用非侵入性逐搏连续血液检测时发现。压力监测系统较少。