EVALUATION OF ORTHOSTATIC HYPOTENSION AND AUTONOMOUS DYSBALANCE IN PATIENTS AFTER CERVICAL SPINAL CORD INJURY.
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| Year of publication | 2012 |
| Type | Conference abstract |
| Citation | |
| Description | The chances of survival in patients after cervical spinal cord injury (SCI) have increased with better acute medical care in the last two decades. Autonomic dysfunction which occurs in these patients (e.g. orthostatic hypotension, OH) is a reason which increases the risk of their cardiovascular mortality. Passive verticalisation is one of the cardiovascular Ewing tests used to investigate the regulation of the autonomous nervous systém (ANS). Also, baroreflex as a shortterm regulator of blood circulation and baroreflex sensitivity (BRS) expressed the sympathovagal balance. The aim of the study was to evaluate OH by objective and subjective methods and to estimate BRS and the variability of blood circulation in patients after cervical SCI. We examined 8 patients (P) with complete SCI on the cervical level: C6-C7 (mean age 30.1, SD 3.8 years) and 15 healthy controls (C). Systolic and diastolic BP (SBP, DBP) and interbeat intervals (IBI) were recorded beat-to-beat by Finometer in all subjects in sitting position on wheelchair for 5 min. Breathing was controlled at a frequency of 0.33 Hz. BRS (ms/mmHg) and BRSf (mHz/mmHg), the variability of BP: SBPrel, DBPrel (r.u.); SBPabs, DBPabs (mmHg2/Hz) and IBI: IBIrel, IBIabs (ms2/Hz) were determined by the spectral method. Continuous measurements of BP were used during a passive verticalisation (10 min) by Thera trainer in each subject for objective detection of OH. Subjective feeling was evaluated by the Borg scale. We confirmed the diagnosis of OH in all patients (decreased SBP: -34, SD 13.0, DBP: -15.5, SD 8.7 mmHg), negative subjective feeling was observed in 4 patients. The depth of these changes is individual and depends on the extent of injury in the individual patient. We found significantly lower SBP in P vs. C (P:102.5 SD 21.7; C:123.0 SD 13.7 mmHg; p<0.05). All variability of BP and IBI was lower (p<0.05) in P vs. C, the baroreflex sensitivity was not different. We conclude that non-invasive continuous measurement of BP completes the examination of the patient with SCI and detects the symptom of OH. The changes of BP variability prove impairment of ANS. |
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