脊髓損傷者起立過程中血流動力與生理參數變化之研究

姿勢性低血壓（postural hypotension）是第六胸髓以上脊髓損傷者，復健過程中常見的問題。本研究的主要目的，在評估起立過程中，脊髓損傷者和正常人之總頸動脈血流量（common carotid blood flow volume）、脈波變化指數（pulsatility index）、心率和血壓的變化與差異。在研究中我們選取六名脊髓損傷者及十五名無心臟血管疾病且年紀相若的正常人為量測對象。我們利用個人電腦，設定電動傾斜床在不同角度（0度、30度、45度、60度、75度），由床邊監視器和電腦系統，負責擷取受測者心率、收縮壓、舒張壓。用杜卜勒超音波量測頸動脈血流量及脈波變化指數。結果顯示正常人在傾斜角度45度以上，心率明顯增加，但血壓、總頸動脈血流量、脈波變化指數不會隨著傾斜角度的增加有明顯的變化，而脊髓損傷者在傾斜角度30度以上，心率明顯增加，在傾斜角度45度以上收縮壓、舒張壓、總頸動脈血流量顯著降低，脈波變化指數明顯上升。由本研究的結果，可以更瞭解脊髓損傷者由平躺到直立過程中，不同角度之血液動力與生理參數變化以及與正常人之差異，並可提供日後研究改善及解決脊髓損傷者的姿勢性低血壓的參考。

關鍵字

姿勢性低血壓；脊髓損傷

並列摘要

Postural hypotension (PH) is a common clinical problem encountered in the rehabilitation of patients with spinal cord injury (SCI) above T6. The purpose of our study was to evaluate the effects of graded head-up tilting on common carotid blood flow volume (CCBFV), pulsatility index (PI), blood pressure (BP), and heart rate (HR) of patients with SCI and of healthy subjects. Six patients with an SCI above T6 level and 15 healthy volunteers were recruited in our study. Their HR and BP at each tilt angle (0°, 30°, 45°, 60°, 75°) were recorded using a bedside monitor and personal computer, and their CCBFV and PI were determined by doppler ultrasound. Patients showed significant decrease of CCBFV and systolic/diastolic BP, and significant increase of PI above a tilt angle of 45° and significant increase of HR above a tilt of angle 30°. For healthy subjects, we recorded significant increase of HR above a tilt angle of 45°, but little changes in CCBFV, systolic/diastolic BP, and PI with increasing tilt angle. The results revealed changes in hemodynamic and physiological parameters of the SCI patients during graded head-up tilting and differences between SCI patients and healthy volunteers. These findings may provide more information for further study to improve the treatment of the SCI patients with PH.

並列關鍵字

postural hypotension ； spinal cord injury

國際替代計量

脊髓損傷者起立過程中血流動力與生理參數變化之研究

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