气压治疗对高位截瘫患者体位性低血压干预的即刻效应观察

目的:观察气压治疗对经过一段时间体位适应性训练后仍存在体位性低血压的22例高位SCI患者的即刻作用,并探讨该治疗的最佳方案。方法:22例患者均分2天在同一时间段内分别完成方案1、2的训练内容。方案1,患者直立床站立期间发生体位性低血压时开始施加气压治疗,之后每5min询问和观察患者的主观感受,并分别测量其收缩压、舒张压和脉搏,直至再次发生体位性低血压为止;方案2,在安静平卧位时即开始施加气压治疗,5min后接受直立床站立训练,站床期间持续气压治疗,直立床角度每升高15°。询问和观察患者的主观感受,并分别测量其收缩压、舒张压和脉搏,直至发生体位性低血压为止。结果:方案2平均站床角度明显大于方案1(59.32±11.78°、37.51±8.96°,P0.05);治疗后两种方案均能使患者收缩压及舒张压显著增高(P0.05),且方案2增高的幅度更大(P0.05)。结论:气压治疗对于长期存在体位性低血压的高位脊髓损伤患者有预防和治疗作用,建议在体位适应性训练中结合使用。     

老年高血压患者体位性血压改变及其对神经认知障碍的影响

目的探索高龄干部人群中高血压患者体位造成血压变化的特点以及体位性血压改变与明显的神经认知障碍的关系。方法对入选77例高血压患者进行卧立位血压测量,体位性低血压(OH)定义为直立位后收缩压下降≥2.6 kPa(20 mmHg)或舒张压下降≥1.3 kPa(10 mmHg),将直立位后收缩压升高≥2.6 kPa(20 mmHg)定义为体位性高血压(OHT),无上述两种异常者定义为体位性血压正常(ONT)。结果在住院高血压患者中,OH发生率18.2%,OHT发生率为9.0%,3组在年龄方面无统计学差异,OH组明显的神经认知障碍发生率显著高于ONT组。结论高龄高血压患者中,OH可能是加重神经认知障碍的重要因素之一。     

抗精神病药引起体位性低血压的观察及护理

本文对256例住院精神分裂症患者服用抗精神病药物期间的体位性血压进行观察,结果显示其体位性低血压的发生率为23.8％,与抗精神病药物剂量有密切关系,且多出现在入院后7～28天。就此提出体位性低血压的护理和预防对策。     

健康青少年女性不同体位右肱动脉血压的研究

目的：研究健康青少年女性不同体位时右肱动脉血压的差异。方法规范测量200名健康青少年女性坐位、平卧位、站立位、左侧卧位、右侧卧位时的血压并进行比较。结果收缩压由高到低依次是坐位、左侧卧位、平卧位、右侧卧位、站立位;舒张压由高到低依次是坐位、左侧卧位、右侧卧位、平卧位、站立位。坐位右肱动脉收缩压、舒张压高于平卧位,差异有统计学意义（P ＜0．05）;左侧卧位右肱动脉收缩压、舒张压高于平卧位,差异有统计学意义（P ＜0．05）;站立位右肱动脉收缩压、舒张压低于平卧位,差异有统计学意义（P ＜0．05）。结论不同的体位可以影响右肱动脉的血压,临床记录血压测量值时要标明体位和肢体。     

医用弹力袜预防截石位老年妇科手术后体位性低血压的效果观察

目的观察应用医用弹力袜在预防老年妇科截石位手术后体位性低血压的效果。方法将60例择期截石位下行妇科阴式手术的老年妇科患者按随机数字表分为观察组和对照组,每组30例。观察组患者在手术前1h穿戴医用弹力袜,两组其他处置及护理措施相同。观察并记录两组患者手术结束后改平卧位前(T1)、即刻平卧(T2)以及改平卧位后5min(T3)、10min(T4)的收缩压、平均动脉压及心率的变化。结果观察组患者体位改变前后各时段收缩压及平均动脉压均无明显变化(均P0.05);对照组T2、T3、T4的收缩压及平均动脉压较T1均明显下降(均P0.05);对照组T2、T3、T4的心率较T1明显增快(P0.05),观察组心率较平稳。结论老年患者截石位妇科手术采用双下肢穿医用弹力袜对预防手术后体位性低血压效果好。     

精神分裂症患者服用抗精神病药物后体重增加的调查分析

目的：探讨抗精神病药对精神分裂症患者体重的影响。方法：对住院首发精神分裂症和分裂样精神病患者服用不同的抗精神病药物，入院时、3个月和1a后测量体重及Quetelet指数的变化。结果：抗精神病药可导致患者体重明显增加、Quetelet指数升高（P＜0．05或P＜0．01）；氯氮平、舒必利等低效价药比氟哌定醇等高效价药更易增加体重。结论：体重增加可影响患者治疗依从性，治疗期间做好心理及饮食护理，注意药物选择。     

高血压的诊断与治疗

1高血压的定义和分级在未用抗高血压药的情况下,非同日3次测量,收缩压≥140mmHg(1mmHg=0.133kPa)和(或)舒张压≥90mmHg,可诊断为高血压。患者既往有高血压史,目前正在服用抗高血压药,血压虽低于140/90mmHg,也可诊断为高血压。     

小剂量氯氮平致直立性低血压12例临床分析及护理

氯氮平为60年代中期出现的新型三环结构抗精神病药,有典型抗精神病作用。由于疗效显著已逐渐被广泛应用于精神科临床,其使用量已达抗精神病药的第一位。氯氮平引起的一般副作用及罕见的粒细胞减少等症屡见报道,但对服用小剂量氯氮平引起直立性低血压的报道则较少,我们对12例服用小剂量氯氮平致直立性低血压的住院患者进行了观察,报道如下。     

老年高血压患者血压昼夜节律紊乱对心率的影响

目的：探讨老年高血压患者血压昼夜节律紊乱对心率的影响。方法选择降压治疗期间诊室血压正常的200例老年单纯收缩期高血压患者,根据动态血压检查结果,分为杓型组56例,非杓型组80例,反杓型组64例,选择健康者32例做为对照组。全部患者进行24 h 动态心电图检查,比较各组与对照组24 h、白昼和夜间的心率水平、心率变异性,分析血压与心率的相关性。结果心率在非杓型组和反杓型组快于杓型组或对照组（P ＜0．01、P ＜0．05）;SDANN、SDNN、rMSSD、PNN50在反杓型组显著降低（P ＜0．01、P ＜0．05）;白昼心率增快与白昼平均收缩压和舒张压增高呈正相关（P ＜0．05）,夜间心率增快与夜间平均收缩压增高呈正相关（P ＜0．05）。结论血压增高与心率增快具有相关性,血压昼夜节律紊乱可使心率增快,心率变异性下降。     

不同体位对老年高血压伴餐后低血压患者血压的影响

目的：探讨餐后不同体位对老年高血压伴餐后低血压患者血压的影响。方法将32例老年高血压伴餐后低血压患者于进食早餐后随机分配为坐位、平卧位及左侧卧位3种体位,采用动态血压计监测餐后2h内血压的变化。结果进餐后无论保持卧位、坐位还是左侧卧位的患者,在进食早餐后45 min出现明显的血压下降,60 min-75 min收缩压与舒张压降至最低点,90 min时逐渐开始回升,120 min时与餐前基本相同（P＞0．05）。不同时点不同体位的收缩压与舒张压监测结果比较差异均无显著性（P＞0．05）。结论餐后不同体位对老年高血压伴餐后低血压患者的血压无明显影响。     

Effect of maternal posture on the umbilical artery flow velocity waveform.

The effect of maternal postural changes on the umbilical artery flow velocity waveform, fetal heart rate and maternal blood pressure was studied in 27 normal singleton pregnancies between 23 and 36 weeks of gestation. A statistically significant change in umbilical artery Pulsatility Index (PI) was established for both maternal standing to supine position (rise) and supine to standing position (drop). These PI changes were not related to gestational age. A statistically significant drop in maternal systolic blood pressure was observed from standing to supine position. The rise in umbilical PI resistance when changing from standing to supine position may be caused by the sluice flow mechanism.     

The effect of different body positions on blood pressure

Aim. The aim of the present study was to test the effects of different body on BP readings in a Turkish healthy young adults. Background. It is known that many factors influence an individual's blood pressure measurement. However, guideliness for accurately measuring blood pressure inconsistently specify that patient's position and they should keep feet flat on the floor. Although there are more information on arm position in blood pressure measurement, surprisingly little information can be found in the literature with respect to the influence of body position on the blood pressure readings in healthy young people. Methods. A total of 157 healthy young students who had accepted to participate in the study were randomly selected. In all subjects the blood pressure was measured subsequently in four positions: Sitting blood pressure was taken from the left arm, which was flexed at the elbow and supported at the heart level on the chair. After at least one minute of standing, the blood pressure was then taken standing, with the arm supported at the elbow and the cuff at the heart level. After one minute of rest, the blood pressure was subsequently taken supine position. Finally, after one minute the blood pressure was again taken in this last position with supine position with crossed legs. Results. The blood pressure tended to drop in the standing position compared with the sitting, supine and supine with crossed legs. Systolic and diastolic blood pressure was the highest in supine position when compared the other positions. There was a difference between systolic blood pressures and this was statistically significant (P < 0·001) but the difference between diastolic blood pressure was not statistically significant (P > 0·05). All changes in systolic blood pressure were statistically significant except those from supine to supine position with crossed legs. Relevance to clinical practice. When assessing blood pressure it is important to take the position of the patient into consideration. Also, blood pressure measurement must be taken in sitting position with the arms supported at the right a trial level.     

Do elderly patients with an excessive fall in blood pressure on standing have evidence of autonomic failure?

1. Blood pressure, heart rate and plasma catecholamine responses were examined in two groups of elderly subjects distinguished by blood pressure responses to standing. Subjects in the control group showed a fall of less than 15 mmHg in systolic blood pressure on standing; subjects in the orthostatic hypotension group had falls of more than 20 mmHg systolic and 10 mmHg diastolic blood pressure on standing. 2. The heart pressure response on standing showed no significant difference between the two groups. 3. The orthostatic hypotension patients had lower plasma noradrenaline concentrations than the control patients (P less than 0.01) in the supine position, but during 10 min standing there was no significant difference in noradrenaline levels between the groups, and the percentage increase of noradrenaline levels in the orthostatic hypotension group was greater (P less than 0.05) than in the control group. 4. In the supine position, diastolic blood pressure was higher (P less than 0.05) in the orthostatic hypotension group than in the control group. 5. We conclude that impairment of baroreceptor function is not involved in most cases of orthostatic hypotension in the elderly, nor is there reduction of sympathetic nervous activity. We suggest that mechanical changes or adrenoreceptor dysfunction are more likely to be important factors in orthostatic hypotension in the elderly.     

Acute effects of increasing doses of urapidil in patients with hypertension

In a randomized, double-blind, dose-ranging trial, the acute antihypertensive effects of 7.5, 15, 30, 45, 60, 90, and 120 mg single daily doses of urapidil were compared with those of placebo in 10 patients with essential hypertension. Patients were randomized to either urapidil or placebo, such that each active drug day was followed by a placebo washout day. Blood pressure and heart rate responses were measured in the supine position, immediately upon standing, and after 3 to 5 minutes of standing for each dose. A variable but significant reduction in systolic and diastolic blood pressures that lasted from 4.5 to 8 hours was observed primarily at the 60, 90, and 120 mg doses (P less than 0.05). The maximum reduction in diastolic blood pressure occurred in the standing position at 3 to 5 hours after dosing. When urapidil was compared with placebo, a change from the supine to the standing positions produced a significantly larger reduction in systolic and diastolic blood pressures (P less than 0.05) but no significant change in heart rate. This suggests an acute blood pressure lowering effect of urapidil that occurs predominantly in the standing position and that does not significantly increase heart rate.     

The impact of arm position on the measurement of orthostatic blood pressure

Blood pressure is a standard vital sign in patients evaluated in an Emergency Department. The American Heart Association has recommended a preferred position of the arm and cuff when measuring blood pressure. There is no formal recommendation for arm position when measuring orthostatic blood pressure. The objective of this study was to assess the impact of different arm positions on the measurement of postural changes in blood pressure. This was a prospective, unblinded, convenience study involving Emergency Department patients with complaints unrelated to cardiovascular instability. Repeated blood pressure measurements were obtained using an automatic non-invasive device with each subject in a supine and standing position and with the arm parallel and perpendicular to the torso. Orthostatic hypotension was defined as a difference of ≥ 20 mm Hg systolic or ≥ 10 mm Hg diastolic when subtracting standing from supine measurements. There were four comparisons made: group W, arm perpendicular supine and standing; group X, arm parallel supine and standing; group Y, arm parallel supine and perpendicular standing; and group Z, arm perpendicular supine and parallel standing. There were 100 patients enrolled, 55 men, mean age 44 years. Four blood pressure measurements were obtained on each patient. The percentage of patients meeting orthostatic hypotension criteria in each group was: W systolic 6% (95% CI 1%, 11%), diastolic 4% (95% CI 0%, 8%), X systolic 8% (95% CI 3%, 13%), diastolic 9% (95% CI 3%, 13%), Y systolic 19% (95% CI 11%, 27%), diastolic 30% (95% CI 21%, 39%), Z systolic 2% (95% CI 0%, 5%), diastolic 2% (95% CI 0%, 5%). Comparison of Group Y vs. X, Z, and W was statistically significant (p < 0.0001). Arm position has a significant impact on determination of postural changes in blood pressure. The combination of the arm parallel when supine and perpendicular when standing may significantly overestimate the orthostatic change. Arm position should be held constant in supine and standing positions when assessing for orthostatic change in blood pressure.     

高血压患者不同体位动态血压的监测

目的了解高血压患者仰卧位、侧卧位、坐位、站立位动态血压测量有否不同。方法对51例动态血压监测的高血压患者,选用右上肢肱动脉测压法,分别测量不同体位的血压。结果仰卧位、左侧卧位、右侧卧位、坐位、站立位时的收缩压平均分别是152.10±14.55、129.21±14.92、150.42±15.54、149.87±14.84、147.85±12.67 mm Hg;舒张压平均分别是87.81±6.92、70.83±8.32、88.33±11.52、88.81±9.15、87.25±11.15 mm Hg。与仰卧位时动态血压测量的结果比较,左侧卧位时收缩压平均低22.89 mm Hg,舒张压平均低16.98 mm Hg,P<0.01;右侧卧位时收缩压平均低1.68 mm Hg,舒张压平均高0.52 mm Hg,P>0.05;坐位时收缩压平均低2.23 mm Hg,舒张压平均高1.00 mm Hg,P>0.05;站立位时收缩压平均低4.25 mm Hg,舒张压平均低0.56 mm Hg,P>0.05。结论高血压患者右侧卧位、坐位、站立位时与仰卧位时动态血压测量的结果无明显变化,左侧卧位时动态血压测量的结果显著低于仰卧位时动态血压测量的结果。     

Comparison of trimazosin and methyldopa in hypertension.

Eighteen patients with hypertension participated in a double-blind, randomized study to evaluate the effect of trimazosin, methyldopa, and placebo on supine and standing blood pressure and heart rate. Of 6 patients on methyldopa, one developed drug fever (and was dropped from the study) and one developed impotence. None of 6 patients on trimazosin and none of 6 patients on placebo developed any adverse effects. The mean supine blood pressure on 900 mg trimazosin daily was 17.0/12.8 mm Hg lower than that on the first placebo trial (p less than 0.01) and 17.0/12.1 mm Hg lower than that on the second placebo trial (p less than 0.01). The mean supine blood pressure on 2,250 mg methyldopa daily was 17.8/12.4 mm Hg lower than that on the first placebo trial (p less than 0.01) and 16.8/13.0 mm Hg lower than that on the second placebo trial (p less than 0.01). The mean supine blood pressure was not significantly affected by placebo. Trimazosin, 900 mg daily, and methyldopa, 2,250 mg daily, were equally effective in lowering supine and standing systolic and diastolic blood pressure and did not affect supine or standing heart rate.     

Effects of low-dose transdermal scopolamine on autonomic cardiovascular control in healthy young subjects

We studied how posture influences the effects of transdermal scopolamine on autonomic cardiovascular regulation in a randomized, double-blind, placebo-controlled crossover study of 10 healthy young volunteers. We recorded the electrocardiogram and auscultatory sphygmomanometric and continuous non-invasive finger arterial pressure (Finapres device) to obtain signals for the beat-by-beat R–R interval and systolic, mean and diastolic pressures. R–R interval and arterial pressure variabilities were characterized by power spectral analysis. Scopolamine increased the mean R–R intervals and reduced arterial pressure in both the supine and the standing positions, but did not affect blood pressure variability. Scopolamine increased the total variability of R–R interval and its mid- (0·07–0·15 Hz) and high- (0·15–0·40 Hz) frequency band power in the standing position during controlled breathing at 0·25 Hz. In the supine position, scopolamine did not affect R–R interval variability. In the deep breathing test, scopolamine increased the maximal expiratory–inspiratory R–R interval ratio. This study showed that low-dose scopolamine increases vagal cardiac inhibition in both supine and standing positions in healthy volunteers. However, scopolamine increases heart rate variability only in the standing position during partial vagal withdrawal. The study also demonstrates that transdermal scopolamine decreases blood pressure in healthy young subjects.     

Haemodynamic effects of intravenous human calcitonin-gene-related peptide in man

1. The effects of intravenous bolus doses of human calcitonin-gene-related peptide (hCGRP) were studied in ten healthy male volunteers. 2.5, 10 and 25 micrograms of hCGRP and placebo were administered to each subject in a randomized double-blind study. 2. hCGRP had no effect on systolic or diastolic blood pressure in the supine or standing position. 3. hCGRP increased supine and standing heart rate. Both the extent and duration of the tachycardia were dose related. 4. Plasma noradrenaline levels were transiently increased after 10 and 25 micrograms of hCGRP. 5. All subjects displayed marked facial flushing after the two higher doses of hCGRP. 6. We conclude that systemic administration of hCGRP produces tachycardia and stimulation of the sympathetic nervous system in the absence of any change in blood pressure.     

Orthostatic circulatory control in the elderly evaluated by non-invasive continuous blood pressure measurement

1. Continuous orthostatic responses of blood pressure and heart rate were measured in 40 healthy and active elderly subjects over 70 years of age in order to assess the time course and rapidity of orthostatic cardiovascular adaptation in old age. 2. During the first 30 s (initial phase) the effects of active standing and passive head-up tilt closely resembled those observed earlier in younger age groups. Standing up was accompanied by a drop (mean +/- SD) in systolic and diastolic blood pressures of 26 +/- 13 mmHg and 12 +/- 18 mmHg, respectively, at around 10 s, and a subsequent rise up to 11 +/- 17 mmHg and 8 +/- 6 mmHg above supine values at around 20 s. The drop in blood pressure upon standing was accompanied by a transient increase in heart rate with a maximum of 13 beats/min, followed by a gradual decrease to 7 beats/min above supine levels. These characteristic transient changes were absent upon a passive head-up tilt. 3. After 1-2 min of standing (early steady-state phase) diastolic blood pressure and heart rate increased significantly after active and passive postural changes. On average, for all subjects systolic blood pressure tended to increase from control during 5-10 min standing, reaching a significant difference at 10 min. During standing, the largest increases in systolic blood pressure were found in subjects with the lowest supine blood pressures. 4. In conclusion, for the investigation of orthostatic circulatory responses in elderly subjects the following factors have to be taken into account: active versus passive changes in posture, the timing of the blood pressure reading, and the level of supine blood pressure.