Changes in Cerebral Blood Oxygenation Induced by Active Standing Test in Children with POTS and NMS
Changes in Cerebral Blood Oxygenation Induced by Active Standing Test in Children with POTS and NMS
复制标题
DOI：
10.1007/978-1-4939-0620-8_34
复制
发表时间：
2014-01-01
期刊：
影响因子：
--
通讯作者：
Skatani, Kaoru
中科院分区：
文献类型：
--
作者：
Endo, Ayumi;Fujita, Yukihiko;Skatani, Kaoru
直立性失调 (OD) 按心率和血压分为不同亚型；然而，大脑的血流动力学尚未被揭示。因此，我们研究了主动站立测试期间脑血流量和氧合的变化，以阐明两种亚型的病理生理学：姿势性心动过速综合征（POTS）和神经介导性晕厥（NMS）。我们研究了 2009 年至 2011 年间在日本大学医学院儿科和儿童健康系就诊的 31 名儿童（15 名男孩，16 名女孩；平均年龄为 14.0 +/- 1.7 岁）。OD 是根据日本青少年直立性失调临床指南诊断的。仰卧位休息10分钟后，要求患者快速起身并保持直立10分钟。使用经颅多普勒超声检查和近红外光谱测量脑血流量和脑氧合。 POTS 显示氧合血红蛋白和阻力指数 (RI) 显着降低，表明短暂性缺血但脑自动调节可维持。 NMS 显示氧合血红蛋白减少和 RI 增加，表明缺血和自动调节受损。
Orthostatic dysregulation (OD) has been classified into subtypes by heart rate and blood pressure; however, the hemodynamics of brains have not yet been revealed. Therefore, we investigated changes in cerebral blood flow and oxygenation during an active standing test to clarify the pathophysiology of two subtypes: postural tachycardia syndrome (POTS) and neurally mediated syncope (NMS). We studied 31 children (15 boys, 16 girls; mean age, 14.0 +/- 1.7 years) who presented with OD at the Department of Pediatrics and Child Health, Nihon University School of Medicine between 2009 and 2011. OD was diagnosed using the Japanese clinical guidelines for juvenile orthostatic dysregulation. After a 10-min resting period in the supine position, patients were asked to quickly stand up and keep upright for 10 min. Cerebral blood flow and cerebral oxygenation were measured using transcranial Doppler sonography and near-infrared spectroscopy. POTS showed a significant decrease of oxy-Hb and resistance index (RI), suggesting transient ischemia with maintainable cerebral autoregulation. NMS showed a decrease of oxy-Hb and an increase of RI, suggesting ischemia and impairment of autoregulation.