脊髓損傷病患直立性暈眩之血氧濃度復原研究

The Recovery Index of Oxygen Saturation from Orthostatic Syncope in Patients with Spinal Cord Injury

劉士偉(David S. Liu) ； 黃美涓(Alice M. K. Wong) ； 陳適卿(Shih-Ching Chen) ； 林康平(Kang-Ping Lin) ； 賴建宏(Chien-Hung Lai) ； 張恆雄(Walter H. Chang)

《台灣復健醫學雜誌》 37卷4期 (2009/12) Pp. 227-234

https://doi.org/10.6315/2009.37(4)02

摘要

脊髓損傷之病患常於復健初期由臥姿到站立或坐起時，產生直立性低血壓，嚴重者造成直立性暈眩現象，傾斜床治療術爲有效且普遍用於治療脊髓損傷病患，逐漸克服直立性暈眩的方法。脊髓損傷病患直立性暈眩之客觀量化指標研究中指出，直立性暈眩指標與血氧濃度爲研究直立性暈眩合適的生理參數，血氧濃度能適當表現出直立性暈眩現象，然而血氧濃度受暈眩程度與傾斜角度影響而變化，因此以血氧濃度表現病患直立性暈眩復原情況將變得困難。
本研究提出兩點假說來有效的評估脊髓損傷病患之直立性暈眩：(1)利用耳垂血氧濃度即時計算暈眩復原指數的方法，其指數數值可以正確描述脊髓損傷病患每次傾斜床訓練時，直立性暈眩的復原的情況，且與實際觀察此次病患傾斜床訓練之暈眩表現趨勢符合；(2)暈眩時之暈眩復原指數與復原後之暈眩復原指數於統計上有顯著差異。研究中以目前血氧濃度與復原後血氧濃度差，相對於最低血氧濃度與復原後血氧濃度之百分比值之平均值，來計算脊髓損傷病患直立性暈眩復原指數。
結果顯示，8位脊髓損傷受試者之暈眩復原指數由暈眩期間的50±22%，顯著進步至直立暈眩復原後88±10%，且受試者之暈眩復原指數數值，能正確定性描述直立暈眩復原的變化。而暈眩期間與復原後之暈眩復原指數間統計上有顯著差異，表示暈眩復原指數不僅能描述暈眩復原情況，復原後之暈眩復原指數有顯著的增加。此外，研究結果亦顯示相鄰訓練間，暈眩復原指數穩定成長，且數值在50%以上，則病患將接近復原。直立性暈眩復原指數不僅能顯示此次訓練的復原效果，也具有預估未來訓練療程的臨床價值，因此證實本研究利用血氧濃度估計直立暈眩復原指數之計算法，在評估脊髓損傷病患直立性暈眩的復原變化爲可行且能獲致良好的效果。
總結來說，本研究直立暈眩復原指數的評估方法，證實可提供脊髓損傷病患在每次傾斜床訓練上，定性與定量顯示直立暈眩復原變化的依據，應能提供醫護人員於脊髓損傷病患傾斜床訓練時之量化依據，也可據此將脊髓損傷病患的復健運動計畫做更精確的規劃。

關鍵字

脊髓損傷 ； 傾斜床 ； 直立性暈眩 ； 血氧濃度

並列摘要

Orthostatic hypotension (OH) is a common clinical problem for patients with spinal cord injury (SCI) at the cervical or high thoracic level when they move from the supine position to the upright position. Patients with severe SCI frequently suffer from symptoms of OH during head-up tilt, ranging from slight lightheadedness to full syncope. Tilt-table training is commonly used in clinical physiotherapy to overcome OH syncope, but this also relies on carefully manual control of the tilt angle and training time by the therapist during training. Up till now, it still has no method to estimate the recovery process of OH syncope.
Therefore, in this study we attempted to use the oxygen saturation (SpO2) responses during tilt table training in patients with SCI to estimate the recovery index of orthostatic syncope. This study collected 8 SCI patients with American Spinal Cord Injury Association (ASIA) grade A. All SCI subjects had a recent history of presyncope symptoms in the early stages of tilt-table training. The SCI patients were trained when they had recovered from any symptoms and had experienced all tilt angles. Before training, subjects were given a 10-min recovery period in a supine position, and then measurements were made at tilt angles of 0, 30, 45, 60, and 75 degree for 6 min each, once per day. All subjects were trained using the same protocol. If the subject appeared discomfort or experienced severe symptoms, training was terminated and the tilt angle was turned back to supine. The recovery condition is designed that patient finish two continuous times of tilt table training without any syncope symptoms. The recovery index from orthostatic syncope was defined as the ratio of the difference between the measured SpO2 and the mean value of SpO2 in the lowest presyncope symptoms and the difference between the recovered value of SpO2 and the mean value of SpO2 in the lowest presyncope symptoms. We tested following hypotheses: (1) that the recovery index can present the recovery process of OH syncope; and (2) that there were significant difference between the training before recovery and training after recovery.
The result showed that the presyncope symptoms in 8 patients occurred from the tilt angle of 45 degree at initial training to the training before recovery, and the levels of presyncope symptoms of patients recovered from level 4 to level 1(no symptom). The recovery indexes had the same trend as the changes of presyncope symptoms during the tilt table training. When the patients suffered from orthostatic syncope (n=53), the recovery index distributed over the range from 26±15% to 68±19%. When the patients had recovered from orthostatic syncope (n=20), the recovery index distributed over the range from 81±9% to 95±6%. All 8 patients had significantly recovered from the mean recovery index of 50±22%, by which patients were syncope existence to the mean value of 88±10%, by which patients had no symptoms (p＜0.05).
We suggested that this recovery index of oxygen saturation was an effective method to estimate whether patients recovered from orthostatic syncope during the rehabilitation, and the recovery index could offer the therapist to design the appropriate rehabilitation training.

並列關鍵字

spinal cord injury ； tilt table ； orthostatic syncope ； oxygen saturation