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首页> 美国卫生研究院文献>other >EFFICACY OF SERVO-CONTROLLED SPLANCHNIC VENOUS COMPRESSION IN THE TREATMENT OF ORTHOSTATIC HYPOTENSION. A RANDOMIZED COMPARISON WITH MIDODRINE
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EFFICACY OF SERVO-CONTROLLED SPLANCHNIC VENOUS COMPRESSION IN THE TREATMENT OF ORTHOSTATIC HYPOTENSION. A RANDOMIZED COMPARISON WITH MIDODRINE

机译：伺服控制的内脏静脉压迫治疗矫治性降压的疗效。米多拉定的随机比较

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Splanchnic venous pooling is a major hemodynamic determinant of orthostatic hypotension (OH), but is not specifically targeted by pressor agents, the mainstay of treatment. We developed an automated inflatable abdominal binder that provides sustained servo-controlled venous compression (40 mmHg) and can be activated only on standing. We tested the efficacy of this device against placebo and compared it to midodrine in nineteen autonomic failure patients randomized to receive either placebo, midodrine (2.5–10 mg) or placebo combined with binder on separate days in a single-blind, crossover study. Systolic blood pressure (SBP) was measured seated and standing before and 1-hour post-medication; the binder was inflated immediately before standing. Only midodrine increased seated SBP (31±5 vs. 9±4 placebo and 7±5 binder, P=0.003); whereas orthostatic tolerance (defined as area under the curve of upright SBP [AUCSBP]) improved similarly with binder and midodrine (AUCSBP, 195±35 and 197±41 vs. 19±38 mmHg*min for placebo, P=0.003). Orthostatic symptom burden decreased with the binder (from 21.9±3.6 to 16.3±3.1, P=0.032) and midodrine (from 25.6±3.4 to 14.2±3.3, P<0.001), but not with placebo (from 19.6±3.5 to 20.1±3.3, P=0.756). We also compared the combination of midodrine and binder, with midodrine alone. The combination produced a greater increase in orthostatic tolerance (AUCSBP, 326±65 vs. 140±53 mmHg*min for midodrine alone, P=0.028, n=21), and decreased orthostatic symptoms (from 21.8±3.2 to 12.9±2.9, P<0.001). In conclusion, servo-controlled abdominal venous compression with an automated inflatable binder is as effective as midodrine, the standard of care, in the management of OH. Combining both therapies produces greater improvement in orthostatic tolerance.
机译：内脏静脉汇集是体位性低血压（OH）的主要血流动力学决定因素，但并未被治疗的主要手段加压剂特异性靶向。我们开发了一种自动充气式腹部粘合剂，可提供持续的伺服控制静脉压迫（40 mmHg），并且只能在站立时激活。我们在单盲，交叉研究中，分别将19例接受安慰剂，米多君（2.5-10 mg）或安慰剂联合粘合剂治疗的自主神经功能衰竭患者，与安慰剂进行了比较，并将其与米多君进行了比较。服药前和服药后1小时测量坐下和站立时的收缩压（SBP）；放置前，粘合剂立即充气。只有米多君增加了坐位收缩压（31±5 vs. 9±4安慰剂和7±5粘合剂，P = 0.003）；而立位耐受性（定义为直立SBP [AUCSBP]曲线下的面积）与粘合剂和米多君类似地改善（AUCSBP，195±35和197±41，而安慰剂为19±38 mmHg * min，P = 0.003）。结合剂（从21.9±3.6降至16.3±3.1，P = 0.032）和米多君（从25.6±3.4降至14.2±3.3，P <0.001）的体位性症状负担降低，但安慰剂组（从19.6±3.5降至20.1±）没有降低3.3，P ＝ 0.756）。我们还比较了米多君和粘合剂的组合以及单独使用米多君的情况。组合产生了更大的体位耐受性（AUCSBP，326±65 vs.仅米多君为140±53 mmHg * min，P = 0.028，n = 21），并减少了体位症状（从21.8±3.2降至12.9±2.9， P ＜0.001）。总之，伺服控制的腹部静脉压迫与自动充气粘合剂在OH的治疗中与咪多君（护理标准）一样有效。两种治疗方法的结合可改善体位耐受性。

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