脊柱刺激时血压升高:回顾自主反射障碍症及其重新定义的必要性
Einat Engel-Haber1,2, Ryan Solinsky3,4, Steven Kirshblum1,2,5
1Tim and Caroline Reynolds Center for Spinal Stimulation, Kessler Foundation, West Orange, NJ, USA.
目前对自主反射障碍 (AD) 的定义对于使用脊髓刺激进行脊髓损伤 (SCI) 康复是不够的. 需要新的共识来解释血压反应并确保患者的安全.
科学领域:
- 神经科学是一个神经科学.
- 心血管生理学心血管生理学
- 康复医学 康复医学 康复医学
背景情况:
- 脊髓刺激越来越多地用于脊髓损伤 (SCI) 康复,促使人们重新评估心血管反应.
- 现有的自主反射障碍 (AD) 的定义可能无法准确地捕捉脊柱刺激期间血压 (BP) 的变化,这导致了研究解释的挑战.
研究的目的:
- 在脊髓损伤 (SCI) 康复中通过脊髓刺激批判性地检查当前自主反射障碍 (AD) 定义的局限性.
- 突出需要精细的AD定义,更好地考虑神经调节疗法期间的心血管反应.
主要方法:
- 现有自主反射障碍 (AD) 定义的文献综述及其在涉及脊髓刺激的脊髓损伤 (SCI) 研究中的应用.
- 分析传统AD值的生理学理由和实际限制 (例如, >20 mmHg的缩血压增加).
主要成果:
- 在脊柱刺激研究中,症状性AD不常见 (4-7%),而无症状的血压升高是常见的.
- 传统的AD值缺乏强大的生理基础,并使治疗性BP调节与不良自主反应的解释变得复杂.
结论:
- 目前的AD定义在脊髓损伤 (SCI) 康复中对研究解释和临床翻译提出了重大挑战.
- 需要共同努力,为脊柱刺激研究制定基于共识的,精细的AD定义,考虑心率,绝对血压和症状状态.
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