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Study on pathophysiological mechanisms responsible for the subset of orthostatic dysregulation and new integrative treatments.

研究直立性失调的病理生理机制和新的综合治疗。

基本信息

批准号：
14570782
负责人：
TANAKA Hidetaka
金额：
$ 2.11万
依托单位：
Osaka Medical College
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
2002
资助国家：
日本
起止时间：
2002 至 2005
项目状态：
已结题

项目摘要

We determined the criteria of four subsets or orthostatic dysregulation ; instantaneous orthostatic hypotension (INOH), postural tachycardia syndrome (POTS), delayed orthostatic hypotension and neurally-mediated syncope (NMS). INOH, sudden drop of blood pressure associated with active standing, is caused by blurred activation of sympathetic activation in the arteriolar vessels. This also involves the excessive pooling of blood in the lower part of the body, thus causing tachycardia during standing. POTS, showing tachycardia >= 115 during standing, is associated with augmentation of sympathetic activity of the heart. The loss of plasma volume or reduction of circulating blood during orthostatic stress is also involved in POTS. NMS is characterized with sudden reduction of blood pressure associated with loss of consciousness with or without cardioinhibitory mechanisms. This episode sometimes develops after severe increase in heart rate during standing in children with INOH and POTS. Thes … More e types of orthostatic intolerance were found to cause impairment of cerebral circulation only during upright posture in about half of the patients, resulting in various disabling symptoms, such as orthostatic dizziness, strong fatigue, fainting and lowering brain function including cognition and thinking. These disadvantages reduce quality of life in patients, thus causing psychological distress as well. There has been one report on the relation between orthostatic intolerance and gene mutation, although we did not find such a patient during the research period. New treatments have been also developed in this study from the biological and psychosocial aspect ; non-pharmacological treatments, medication and psychosocial support. The first alternative includes the repair of circadian rhythm, exercise training with adequate degree and sodium / water intake. We also invented an inflatable abdominal bandage which inhibits blood pooling in the lower part of the body. Regarding medication midodline was found as a most effective and a safe drug for INOH and POTS. We established the comprehensive support network system for patients with orthostatic dysregulation and school absenteeism from the bio-psycho-socio-ethical aspect. In this system, we incorporated a new occupational stuff, named "mental associates", who is usually an university postgraduate is expected to visit home of a child with school absenteeism and psychosomatic diseases for the purpose of metal support, tutoring and rehabilitation in society, under the control of medical specialists. A trained mental associate carried out his task according to the elaborated original program. We have experienced 17 cases. A mental associate performed a task once a week for 90 minutes including going out home and step-by-step tutoring, resulting recovery of emotional steadiness, decision-making and sociality. Less

我们确定了立位调节障碍的四个子集的标准：瞬时直立性低血压（INOH），姿势性心动过速综合征（POTS），迟发性直立性低血压和神经介导性晕厥（NMS）。INOH，与主动站立相关的血压突然下降，是由小动脉血管中交感神经激活的模糊激活引起的。这也涉及血液在身体下部的过度淤积，从而导致站立时的心动过速。POTS在站立时显示心动过速>= 115，与心脏交感神经活动的增强有关。血浆容量的损失或减少循环血液在直立应激过程中也涉及POTS。NMS的特征是血压突然降低，伴有或不伴有心脏抑制机制的意识丧失。这种发作有时发生在患有INOH和POTS的儿童站立时心率严重增加之后。Thes ...更多信息 5类立位耐力不良仅在直立位时发生脑循环障碍，约半数患者出现立位性头晕、强烈疲劳、晕厥等多种致残症状，认知、思维等脑功能下降。这些不利因素降低了患者的生活质量，从而也造成了心理困扰。关于立位耐力不良与基因突变的关系已有1例报道，但在研究期间我们没有发现这样的患者。本研究还从生物学和心理社会学方面开发了新的治疗方法;非药物治疗，药物治疗和心理社会支持。第一种选择包括昼夜节律的修复，适当程度的运动训练和钠/水的摄入。我们还发明了一种可充气的腹部绷带，它可以抑制血液在身体下部积聚。关于药物治疗，米多德林被认为是INOH和POTS最有效和最安全的药物。从生物、心理、社会、伦理等方面建立立位调节障碍和缺课患者的综合支持网络系统。在这个系统中，我们纳入了一个新的职业的东西，命名为“心理伙伴”，谁通常是一个大学研究生，预计将访问一个孩子的家与学校旷课和心身疾病的目的，金属支持，辅导和康复的社会，在医疗专家的控制下。一个训练有素的心理助手根据精心设计的原始程序执行他的任务。我们经历了17个案例。一个心理伙伴每周执行一次任务，持续90分钟，包括回家和一步一步的辅导，结果恢复了情绪稳定，决策和社交能力。少