Impact of body position on central and peripheral hemodynamic contributions to movement-induced hyperemia: implications for rehabilitative medicine.
Impact of body position on central and peripheral hemodynamic contributions to movement-induced hyperemia: implications for rehabilitative medicine.
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身体位置对运动引起的充血的中枢和外周血流动力学贡献的影响：对康复医学的影响。
DOI：
10.1152/ajpheart.00038.2011
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
Richardson,RussellS
中科院分区：
文献类型：
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作者：
Trinity,JoelD;McDaniel,John;Venturelli,Massimo;Fjeldstad,AnetteS;Ives,StephenJ;Witman,MelissaAH;Barrett-O'Keefe,Zachary;Amann,Markus;Wray,DWalter;Richardson,RussellS
这项研究通过改变体位来确定被动运动后血液动力学反应的差异。14名受试者在被动膝关节伸展2分钟时无创测量中央和外周血流动力学，而6名受试者直接测量灌注压（PP）。运动引起的腿部血流量（LBF）和腿部血管导度（LVC）的增加在直立位置比仰卧位置多两倍以上（LBF，仰卧：462±6，直立：1,084±159 ml/min，P< 0.001； LVC，仰卧：5.3±1.2，直立：11.8±2.8 ml·min−1·mmHg−1，P< 0.002）。不同体位（仰卧位：8±1次/min，直立位：10±1次/min，P= 0.22）的心率（HR）从基线到峰值的变化无显著差异；然而，直立时升高的心率维持的时间更长。仅在直立运动时，卒中量对心输出量（CO）的增加有贡献。两个位置CO均增加；然而，在直立位置，CO反应的幅度和持续时间更大。平均动脉压和PP在基线时和直立时的被动运动中较高。因此，以卒中量增加和持续HR反应为特征的夸张的中央血流动力学反应，在直立运动时产生更大的CO增加。这种更大的中枢反应，加上PP和LVC的增加，解释了直立姿势时运动引起的充血比仰卧姿势时的两倍更大、更持久的增加，并对康复医学具有临床意义。
This study used alterations in body position to identify differences in hemodynamic responses to passive exercise. Central and peripheral hemodynamics were noninvasively measured during 2 min of passive knee extension in 14 subjects, whereas perfusion pressure (PP) was directly measured in a subset of 6 subjects. Movement-induced increases in leg blood flow (LBF) and leg vascular conductance (LVC) were more than twofold greater in the upright compared with supine positions (LBF, supine: 462 ± 6, and upright: 1,084 ± 159 ml/min,P< 0.001; and LVC, supine: 5.3 ± 1.2, and upright: 11.8 ± 2.8 ml·min−1·mmHg−1,P< 0.002). The change in heart rate (HR) from baseline to peak was not different between positions (supine: 8 ± 1, and upright: 10 ± 1 beats/min,P= 0.22); however, the elevated HR was maintained for a longer duration when upright. Stroke volume contributed to the increase in cardiac output (CO) during the upright movement only. CO increased in both positions; however, the magnitude and duration of the CO response were greater in the upright position. Mean arterial pressure and PP were higher at baseline and throughout passive movement when upright. Thus exaggerated central hemodynamic responses characterized by an increase in stroke volume and a sustained HR response combined to yield a greater increase in CO during upright movement. This greater central response coupled with the increased PP and LVC explains the twofold greater and more sustained increase in movement-induced hyperemia in the upright compared with supine position and has clinical implications for rehabilitative medicine.