以直立性低血压为主要表现的Shy-Drager综合征42例分析

该文探讨Shy-Drager综合征的临床表现,以便早期诊断治疗。方法 :回顾性分析经临床诊断的42例Shy-Drager综合征患者的相关资料。结果 :Shy-Drager综合征患者临床表现为直立性低血压42例,卧立位压差平均为36/22mmHg(收缩压差/舒张     

严重直立性低血压一例

<正>1临床资料患者男性,46岁,因"发作性头晕5年,行走不稳1年余"于2015年2月4日入院。患者5年前开始从坐位或卧位起立后出现头晕,表现为头重脚轻,伴一过性黑矇、出冷汗,测血压50~60/30~40 mm Hg,每次发作均在体位改变及活动后出现,持续数分钟不等,蹲下或平卧后可缓解。曾使用米多君及中医中药治疗,效果不佳。患者3年前逐渐出现尿频、排尿无力,无尿潴留。1年多前逐渐出现走路摇摆、步     

老年人直立性低血压

老年门诊病人直立性低血压的发生率为20％,75岁以上者高达30％。老年人的用药和疾病是发生直立性低血压的决定因素之一。本文着重讨论直立性低血压的病理生理、诊断和治疗。     

直立性低血压27例临床分析

<正>直立性低血压是导致心肌梗死,脑卒中的危险因素。本文对27例直立性低血压进行临床分析,现报告于下。1 临床资料1.1 一般资料:27例病人中男14例,女13例,年龄37-76岁,平均年龄52.5±12.5岁,其中既往有低血压病9例,自主神经功能障碍7例,吉兰一巴雷综合征6例,多发性周围神经炎伴糖尿病5例。1.2 临床表现:27例患者均有头晕、乏力、眼花、下肢发软。7例突发性晕厥l-3次。9例有性功能减退及阳萎,8例尿潴留,10例便秘。5例少汗或无汗。9例眼运动受限,瞳孔不等大,对光反射迟钝。5例虹膜可见萎缩,6例有Horner征阳性。7例皮肤划痕试验减弱或消失。11     

老年人直立性低血压

直立性低血压在老年人群发生率约占２０％～３０％,其临床表现为头昏、乏力,甚至晕厥,尤其是不能解释的跌倒老人。低血压与直立性低血压的危险性还在于导致老年人骨折、心肌梗死、脑卒中,严重影响老年人生活质量。本文对其发病机理及防治方法作一综述。１　概念〔１～６〕正常人动脉血压水平是１３０／８５ｍｍＨｇ左右（收缩压／舒张压）。收缩压低于１００ｍｍＨｇ时称为低血压,而直立性低血压之含义则与之不同：当患者直立时,血压突然下降,临床可出现与其相应的脑血流灌注不足之症状如头晕、乏力、视力模糊、语言不清、平衡失调,…     

老年直立性低血压的处理

直立性低血压(OH)是一临床常见的病症,对老年人的寿命影响尤甚,它可导致健康的进行性衰退。本文介绍在老年人中发生这种病症的主要原因、病理生理变化以及临床判定指征和鉴别诊断,并提出一个探讨治疗(OH)的分步骤处理方案。这个分步骤处理方案用药物的最小剂量来达到最大限度的疗效,因此,药物的副作用也很小。     

衰老与直立性低血压

直立性低血压(OH)是老年病人的常见疾病。以往的一些研究报告,调查了本病的流行病学和发病机理,但大多是对患有已知可引起OH的疾病和使用这类药物的病人所进行的研究。混淆了正常衰老、疾病及药物作用对OH的有关影响。本文综述了经筛选和非筛选的老年人群中OH的测量方法、流行病学和发病机理。评价与年龄相关的生理变化、老年人OH与其他型OH的关系,并概要提出目前和今后探讨的范围。     

直立性低血压的研究进展

本文论述了国外对直立性低血压在病因，发病机制及治疗方面的研究近况，强调了神经源性或非神经源性病因的确定对直立性低血压诊断及治疗的重要意义，也强调了个体化疗的重要性，指出，目前的治疗仅能减轻直立性低血压的症状，但未能逆转及稳定这种自主神经障碍的疾病进程。     

老年直立性低血压1例报告

<正>1临床资料患者男性,78岁,主因"间断头晕3年,加重2个月,跌倒1h"入院。患者3年前出现间断头晕,以劳累和休息欠佳时为著,多次就诊于当地医院神经内科,行头颅CT、MRI、经颅多普勒超声等检查提示:腔隙性脑梗死、局部脑血流速度增快。多次以"脑动脉供血不     

Shy-Drager综合征一例

患者,男,45岁,因乏力10年,小便失禁4年、反复晕厥、行走不稳10月,于2004年11月10日入院。患者于10年前出现全身乏力、阳痿、出汗多,能够进行正常劳动。4年前出现小便失禁,2年前出现视物不清,1年前讲话语调低,言语缓慢,发音不清,间断耳呜。10月前出现反复晕厥,均在站立几分钟后出现,伴头昏,头昏卧位消失,坐位加重,伴行走不稳如醉酒状,4月前出现便秘,皮肤干燥无汗。体检：T36、5℃,P76次J分,     

Shy-Drager综合征26例的临床分析

目的:探讨Shy-Drager综合征(SDS)的临床和辅助检查的特点,为临床诊断提供依据。方法:回顾性分析26例临床诊断为SDS患者的临床资料、头颅磁共振(MRI)、肛门括约肌肌电图(EAS-EMG)、校正QT间期和尿流动力学检查。结果:14例患者行头颅MRI检查,6例患者出现壳核T2低信号。19例患者行EAS-EMS检查,均有自发电位。13例患者行尿流动力学检查,9例有尿道流出梗阻现象。20例患者行心电图检查,平均校正QT间期达0.409 ms。结论:临床表现结合头颅MRI和EAS-EMG有助于提高SDS的诊断。     

Orthostatic blood pressure control in Marfan's syndrome

A 33-year old male patient, with Marfan's syndrome, reportedsymptoms of orthostatic intolerance and fatigue as a longstandingproblem. Orthostatic cardiovascular examination showed poororthostatic tolerance, with a rise in heart rate and a fallin arterial blood pressure and cerebral blood flow velocity.Self-discovered physical counterpressure manoeuvers improvedsymptoms, related to a substantial increase in arterial pressureand cerebral perfusion. When orthostatic complaints are reportedby patients with Marfan's syndrome, physical counterpressuremanoeuvers should be advised to reduce symptoms of posturalhypotension.     

Tilt-test diagnosis of hypotensive transient ischaemic attacks

Eight elderly patients with postural hypotension who presented with transient ischaemic attacks are reported. Six patients underwent head-up tilt testing with continuous blood pressure monitoring. During tilt, postural hypotension was found in five patients and in three patients transient ischaemic attacks were reproduced. Postural hypotension is probably a rare cause of transient ischaemic attacks, but may be underrecognized.     

Orthostatic hypotension: pathophysiology,assessment, treatment and the paradox of supine hypertension

Both hypertension and orthostatic hypotension (OH) are strongly age‐associated and are common management problems in older people. However, unlike hypertension, management of OH has unique challenges with few well‐established treatments. Not infrequently, they both coexist, further compounding the management. This review provides comprehensive information on OH, including pathophysiology, diagnostic workup and treatment, with a view to provide a practical guide to its management. Special references are made to patients with supine hypertension and postprandial hypotension and older hypertensive patients.     

Postural orthostatic tachycardia syndrome: diagnosis and treatment

Background

Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by an exaggerated increase in heart rate that occurs during standing, without orthostatic hypotension. Women are most frequently affected, and may present with palpitations, chest discomfort, shortness of breath, weakness, exercise intolerance, lightheadedness, presyncope, and syncope.

Methods

We present three cases of POTS in otherwise healthy women, and discuss the clinical management of different types of this orthostatic intolerance.

Results and conclusion

The diagnosis was established with a tilt-table test in 1 patient who became symptom-free with β-blockade and nonpharmacologic treatment, including fluid therapy, liberal sodium intake, support hose, and a reconditioning exercise program. The other 2 were diagnosed through a standing test, serum norepinephrine levels, and red-cell volumes. One patient had neuropathic POTS and partially responded to b-blockade and nonpharmacotherapy. The other patient had hyperadrenergic POTS and responded well to nonpharmacotherapy, a dualacting b-blocker, and a vasoconstrictor agent. Postural orthostatic tachycardia syndrome is not an uncommon clinical entity and making a correct diagnosis is crucial in providing appropriate treatment to restore patients' functional capability and quality of life.     

Postural orthostatic tachycardia syndrome: an underrecognized disorder

Background: Postural orthostatic tachycardia syndrome (POTS), a clinical syndrome of orthostatic intolerance characterized by excessive tachycardia and symptoms of cerebral hypoperfusion on standing, is not well recognized in Australia. The aim was to study the clinical symptomatology, results of autonomic testing and outcome in patients with POTS. Methods: Sixteen subjects from a tertiary referral centre who met the criteria for POTS were studied between January 2003 and January 2006. Ten of these patients consented to be interviewed using a validated autonomic symptom questionnaire. Heart rate responses to deep breathing and the Valsalva manoeuvre were measured using Colin BP‐508 machine (WR Medical Electronic Co., Stillwater, MN, USA). Tilt studies were carried out for 10 min to 80° of head‐up tilting. Patient outcome was assessed as functionally normal, able to stand 30 min without symptoms, able to work and carry out recreational activities or worse on follow up. Results: The mean age of 10 subjects was 24.9 ± 6.8 years, six being women. The mean duration of symptoms was 70.7 months (range 3–228 months). The common presenting orthostatic symptoms were light‐headedness (100%), palpitations (90%), pallor (90%), weakness (80%) and clammy skin (80%). The mean heart rate increment during the tilt study was 51.7 ± 14.3 b.p.m. The mean duration of follow up was 8.9 months (range 1–16 months). Only five patients were functioning normally at the follow‐up visit. Conclusion: POTS is an underrecognized but persistent autonomic disorder in young patients with a variety of symptoms and variable outcome.     

Clinical approach to autonomic dysfunction

Patients with autonomic dysfunction may present with a variety of seemingly unrelated symptoms, both generalised and involving specific systems, including fatigue, difficulty concentrating, orthostatic intolerance, palpitations, constipation or diarrhoea, early satiety, urinary retention or incontinence and erectile dysfunction. Failure to connect the diverse symptoms with a single underlying mechanism may lead to incorrect diagnoses, inappropriate interventions and frustration on the part of both doctors and patients. We describe recent developments in the understanding of the pathophysiology of autonomic dysfunction, including the link between the autonomic and immune systems resulting in the ‘inflammatory reflex’. We then provide a rationale to guide the management of patients exhibiting features of autonomic dysfunction, including postural tachycardia syndrome.     

Noninvasive beat‐to‐beat finger arterial pressure monitoring during orthostasis: a comprehensive review of normal and abnormal responses at different ages

Over the past 30 years, noninvasive beat‐to‐beat blood pressure (BP) monitoring has provided great insight into cardiovascular autonomic regulation during standing. Although traditional sphygmomanometric measurement of BP may be sufficient for detection of sustained orthostatic hypotension, it fails to capture the complexity of the underlying dynamic BP and heart rate responses. With the emerging use of noninvasive beat‐to‐beat BP monitoring for the assessment of orthostatic BP control in clinical and population studies, various definitions for abnormal orthostatic BP patterns have been used. Here, age‐related changes in cardiovascular control in healthy subjects will be reviewed to define the spectrum of the most important abnormal orthostatic BP patterns within the first 180 s of standing. Abnormal orthostatic BP responses can be defined as initial orthostatic hypotension (a transient systolic BP fall of >40 mmHg within 15 s of standing), delayed BP recovery (an inability of systolic BP to recover to a value of >20 mmHg below baseline at 30 s after standing) and sustained orthostatic hypotension (a sustained decline in systolic BP of ≥20 mmHg occurring 60–180 s after standing). In the evaluation of patients with light‐headedness, pre(syncope), (unexplained) falls or suspected autonomic dysfunction, it is essential to distinguish between normal cardiovascular autonomic regulation and these abnormal orthostatic BP responses. The prevalence, clinical relevance and underlying pathophysiological mechanisms of these patterns differ significantly across the lifespan. Initial orthostatic hypotension is important for identifying causes of syncope in younger adults, whereas delayed BP recovery and sustained orthostatic hypotension are essential for evaluating the risk of falls in older adults.