Instantaneous orthostatic hypotension in children and adolescents: A new entity of orthostatic intolerance
Instantaneous orthostatic hypotension in children and adolescents: A new entity of orthostatic intolerance
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DOI：
10.1203/00006450-199912000-00009
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发表时间：
1999-12-01
影响因子：
3.6
通讯作者：
Tamai, H
中科院分区：
文献类型：
--
作者：
Tanaka, H;Yamaguchi, H;Tamai, H
我们首次报道了44例瞬时体位性低血压（INOH）患儿的临床特征和循环和儿茶酚胺对体位变化的反应。症状包括慢性疲劳、直立性头晕、虚弱、睡眠障碍、晕厥或近晕厥、头痛和食欲不振。我们将患者分为两组：第一组（30例）平均动脉压恢复时间为25秒或恢复时间为20秒，平均动脉压在最初下降时下降60%或更高；除i组标准外，II组（14例）在站立后期（3-7分钟）收缩压持续下降约15%。INOH的特点是血压在初始降低时显着降低（平均收缩压/舒张压为-55/-27 mm Hg）。44例患者中21例出现>延迟恢复时间60秒，20例出现直立性心动过速（>35次/分）。血浆去甲肾上腺素反应在站立1分钟时显著低于对照组，在站立5分钟时显著低于对照组。这些结果表明，INOH的机制可能取决于站立时交感神经激活不足，可能是由于中央介导的交感神经抑制，从而导致生活质量受损，包括旷课。INOH是一种重要的病理条件，在儿童申诉直立不耐受，可以是慢性疲劳的一个未被认识的原因。这种情况可以通过使用无创连续血压监测系统来识别。
We are the first to report clinical characteristics and circulatory and catecholamine responses to postural change in 44 children with instantaneous orthostatic hypotension (INOH). The symptoms include chronic fatigue, orthostatic dizziness, weakness, sleep disturbance, syncope or near syncope, headache, and loss of appetite. We divided the patients into two groups: group I (30 patients) had either a recovery time for mean arterial pressure of >25 s or a recovery time of >20 s with a 60% or greater decrease in mean arterial pressure at the initial decrease; group II (14 patients) had a prolonged reduction in systolic arterial pressure of >15% during the later stage of standing (3-7 min) in addition to the criteria for group I. INOH was characterized by a marked reduction in blood pressure at the initial decrease (mean, -55/-27 mm Hg systolic/diastolic). Delayed recovery time of >60 s was found in 21 of 44 patients and orthostatic tachycardia (>35 beats per minute) in 20 of 44. Plasma noradrenaline responses were significantly lower in group I and II than in controls at 1 min of standing and were lower in group II at 5 min of standing. These results suggest that mechanisms responsible for INOH may depend on insufficient sympathetic activation during standing, possibly due to centrally mediated sympathetic inhibition, thus causing impairment of quality of life including school absenteeism. INOH is an important pathologic condition in children with complaints of orthostatic intolerance and can be an unrecognized cause of chronic fatigue. This condition can be identified by using a noninvasive beat-to-beat continuous blood pressure monitoring system.