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Medicine

倾斜试验结合下体负压测量立位耐力的“金标准”

Published: March 21, 2013
doi:
10.3791/4315
, , ,
1Department of Biomedical Physiology and Kinesiology,Simon Fraser University

Summary

我们描述了一个“金标准”，以评估使用倾斜试验（OT）联合下体负压（LBNP）的立位耐力。这可以结合与心血管反射控制的非侵入性评价。正常和不正常的反应被定义。

Abstract

立位耐力（OT）是指能够保持心血管稳定直立时，对静压重力​​的作用，从而维持脑灌注，防止晕厥（昏倒）。有多种技术可用来评估OT和自重应力的影响血液循环后，一般的做法是在受控的实验室环境中再现晕厥前的事件（近昏厥发作）。需要引起这种反应的时间和/或程度的压力OT措施。任何技术用于确定OT：使立位耐力（各种原因引起的）和无症状对照组患者之间的区别是高度可重复性，使评价治疗干预，避免侵入性操作，这是众所周知的损害OT 1。

在20世纪80年代末，头直立倾斜试验用于诊断晕厥2。硅NCE，它已被用来评估OT不明原因的晕厥患者，以及在健康受试者研究的姿势心血管反射2-6。倾斜的协议包括三类：被动倾斜，伴随着药理挑衅的被动倾斜;结合下体负压（LBNP）和被动倾斜。然而，倾斜试验（和其他体位性压力测试的方式）的影响往往是很难再现，低灵敏度和特异性诊断体位性不耐受。

通常情况下，被动倾斜，包括体位性压力持续20-60分钟，直到晕厥发作的患者2-6。然而，此过程的主要缺点是它不能调用晕厥进行试验，在所有个体和相应的低灵敏度8,9。因此，不同的方法进行了探讨，以提高立位应激和提高灵敏度。

药理挑衅已被用来增加体位性挑战，例如使用异丙肾上腺素4,7,10,11或舌下硝酸12,13。然而，这些方法的主要缺点是在不可接受的跌幅的特异性10,14的成本的增加的灵敏度，具有高的正反应率立即给药后15。此外，侵入性操作有一定的药理挑衅，大大增加了假阳性率1。

另一种方法是被动倾斜试验相结合，提供了更强的立位应激与LBNP无侵入性程序或药物副作用，使用这项技术，开创教授罗杰Hainsworth又在20世纪90年代16-18。在几乎所有科目（允许在晕厥患者症状的识别），而区分不稳定型心绞痛患者，这种做法引发晕厥新界南总区有晕厥和健康对照组，特异性为92％，敏感性为85％，重复性为1.1±0.6分钟16,17。这，不仅可以诊断和病理评估19-22的评价，但也由于其高重复性23-30立位耐力的治疗方法。由于这些原因，我们认为这应该是体位性压力测试的“金标准”，因此，这将是本文中所描述的方法。

Protocol

在整个测试中，连续拍来拍血压和心电图（ECG）监测是至关重要的。这确保受试者的安全，并及时终止测试与晕厥发作。节拍可以通过动脉插管，或手指体积描记法31-33击败血压记录。后者用于在该协议中，因为它是非侵入性的，可以评估的发生晕厥与留置31,34相同的精度，没有侵入性的监测OT 1的不利影响。使用的Modelflow技术的每搏输出量的变化，心输出量和总外周阻力?…

Representative Results

使用此协议，所有科目的经验晕厥，正常或异常反应的定义主要是根据观察到这种反应所需要的时间。 OT晕厥时间（分钟）被定义为从发病直立倾斜。 OT在健康志愿者中的典型值可以根据年龄和性别表1中可以看出，早在测试中表现出与立位耐力晕厥患者，有85％内控制17相比，23％的-20毫米汞柱阶段的结束测试。正常的阈值定为20％的发病率晕厥17。 <p class="jove_conten…

Discussion

这种技术是重现性好，有能力区分正常和异常反应具有很高的灵敏度和特异性，可以引起晕厥在所有科目，让患者反复发作晕厥的症状的识别。在临床上，可以区分，不同类型的晕厥，进行针对性的治疗和管理方法。可以很容易地评估干预措施的影响。额外的心血管监测，反射性的反应也可以进行评估。

为了区分某些类型的晕厥患者人群，立位应激时血浆儿茶酚胺的反应分?…

Disclosures

The authors have nothing to disclose.

Acknowledgements

我们要感谢教授罗杰的海恩斯沃思，谁开发这种技术。我们感谢他们的协助与摄影王杭超先生和胡王先生乔。

这项工作是由西蒙·弗雷泽大学和加拿大心脏及中风基金会的支持。

Materials

Equipment Manufacturer Location
Tilt Table Custom-build Leeds, United Kingdom
Finometer Finapres Medical Systems Amsterdam, The Netherlands
Doppler Box Compumedics Singen, Germany
Doppler software The DWL Doppler Company Singen, Germany
Aquasonic Ultrasound gel Parker Laboratories, Inc. Fairfield, USA
Headbands Lululemon Burnaby, Canada
Headset Canadian Tire Burnaby, Canada
ECG Finapres ECG Module, Finapres Medical Systems Amsterdam, The Netherlands
Electrodes Red Dot Ontario, Canada
Antiseptic Isopropyl Alcohol Pads Lernapharm Quebec, Canada
O2Cap-Oxygen Analyser Oxigraph Inc. California, USA
Airlife Nasal Oxygen Cannula Cardinal Health Mountainview, USA
Powerlab 16/30 AD Instruments Colorado Springs, USA
DOWNLOAD MATERIALS LIST

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Tags

Tilt TestingCombined Lower Body Negative PressureOrthostatic ToleranceCardiovascular StabilitySyncopePresyncopal EventGravitational StressOrthostatic IntoleranceReproducibilityTherapeutic InterventionsInvasive ProceduresHead-upright Tilt TestingSyncope DiagnosisPostural Cardiovascular ReflexesTilting ProtocolsPharmacological ProvocationLBNP

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Protheroe, C. L., Ravensbergen, H. (. J., Inskip, J. A., Claydon, V. E. Tilt Testing with Combined Lower Body Negative Pressure: a “Gold Standard” for Measuring Orthostatic Tolerance. J. Vis. Exp. (73), e4315, doi:10.3791/4315 (2013).
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