Regional blood flow response to orthostasis in patients with congestive heart failure.
Regional blood flow response to orthostasis in patients with congestive heart failure.
复制标题
充血性心力衰竭患者体位性局部血流反应。
DOI：
10.1016/s0735-1097(83)80041-2
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发表时间：
1983
影响因子：
24
通讯作者：
Cohn,JN
中科院分区：
文献类型：
--
作者：
Goldsmith,SR;Francis,GS;Levine,TB;Cohn,JN
为探讨充血性心力衰竭患者立位时的中枢和局部循环反应，对22例患者在仰卧位和65°头高位时的血流动力学参数、前臂和肝脏血流量进行了测定。并与9例正常人进行比较。心率和平均动脉血压在正常人倾斜时增加，但心力衰竭患者不增加。正常受试者的前臂血流量从3.7 ± 1.1 ml/min/100 g降至2.7 ± 1.5 ml/min/100 g（概率[p] < 0.02），但患者的前臂血流量与较低的基线（1.65 ± 0.78 ml/min/100 g）相比没有变化。前臂血管阻力增加，正常人，但没有在患者。倾斜期间，两组的肝血流量均未发生变化，但正常受试者的肝血管阻力从0.37 ± 0.13 U增加到0.47 ± 0.15 U（p < 0.02）。在患者中未观察到增加（1.2 ± 1.1至1.4 ± 1.0 U，p =不显著[NS]）。总体循环阻力从1,848 ± 560增加到2,132 ± 731 dynes·s·cm-5（p < 0.005），表明某些血管床的阻力确实增加。这些患者的血浆去甲肾上腺素也适度增加，从665 ± 377增加到761 ± 379 pg/ml（p = 0.035），但血浆去甲肾上腺素的个体变化与肝脏或前臂阻力的变化无关。充血性心力衰竭患者的总体血流动力学反应和局部血流和阻力的调节在几个方面不同，与正常的科目。患者的心率、血压、前臂血流、前臂和肝血管阻力的变化都变钝。差异的原因尚不清楚，但可能与充血性心力衰竭患者循环反射控制异常有关。
To investigate the central and regional circulatory response to orthostasis in congestive heart failure, hemodynamic variables and forearm and hepatic blood flow were measured in 22 patients at supine rest and during a 65° head-up tilt. Results were compared with those in nine normal subjects. Heart rate and mean arterial blood pressure increased during tilt in normal subjects, but not in patients with heart failure. Forearm blood flow decreased in normal subjects from 3.7 ± l.lto2.7± 1.5 ml/min per 100 g (probability [p] < 0.02), but did not change from a lower baseline (1.65 ± 0.78 ml/min per 100 g) in patients. Forearm vascular resistance increased in normal subjects but not in patients. Hepatic blood flow did not change during tilt in either group, but hepatic vascular resistance increased in normal subjects from 0.37 ± 0.13 to 0.47 ± 0.15 U, (p < 0.02). The increase was not seen in patients (1.2 ± 1.1 to 1.4 ± 1.0 U, p = not significant [NS]). Total systemic resistance increased in patients from 1,848 ± 560 to 2,132 ± 731 dynes·s·cm-5 (p < 0.005) indicating that resistance did increase in some vascular beds. Plasma nor-epinephrine also increased modestly in these patients from 665 ± 377 to 761 ± 379 pg/ml (p = 0.035), but individual changes in plasma norepinephrine did not correlate with changes in hepatic or forearm resistance.Thus, both the overall hemodynamic response and the regulation of regional blood flow and resistance differ in several respects in patients with congestive heart failure when compared with normal subjects. Changes in heart rate, blood pressure, forearm flow and forearm and hepatic vascular resistance are all blunted in patients. Reasons for the differences are not yet clear, but may be associated with abnormalities in reflex control of the circulation in patients with congestive heart failure.