全身振动治疗对脊髓损伤恢复期患者直立耐受性的生理效应影响

关键词：全身振动  脊髓损伤  直立耐受性  血流动力学反应

Keywords:whole body vibration  spinal cord injury  orthostatic tolerance  hemodynamic response

摘要：

      摘要 目的：探讨不同频率全身振动治疗(whole body vibration， WBV)对T6及以上平面ASIA A级和 B级脊髓损伤(spinal cord injury， SCI)恢复期患者直立耐受性的急性生理效应。 方法：选取21例T6及以上平面ASIA A级和B级，病程在3个月以上的脊髓损伤患者(A组)，并选取年龄性别与之匹配的正常受试者20例(B组)。受试者被束缚于电动起立床上，分别于平卧位3min(T0)、床面与地面成60°夹角3min(T1)、全身振动治疗3min(T2)、振动停止后3min(T3)、床面降至水平3min(T4)，全身振动频率分别为0Hz，10Hz和20Hz，并在每个时间点对患者进行无创血流动力学监测和体位性低血压症状评估量表(orthostatic hypotension symptom assessment， OHSA)评价。对上述结果进行组间及组内比较。 结果：与0Hz相比，10Hz、20Hz组T2、T3、T4时间点的心率(heart rate， HR)明显降低，体位性低血压症状评分明显下降；T2、T3时间点平均动脉压(mean arterial pressure， MAP)、心输出量指数(cardiac output index， CI)均明显升高；T2时间点每搏输出量指数(stroke volume index， SVI)明显升高；20Hz组T2、T3时间点总外周阻力指数(total peripheral resistance index， TPRI)明显升高；差异有显著性意义(P<0.05)。与对照组相比，0Hz组T1—T0时平均动脉压、心输出量指数、每搏输出量指数明显降低，T2—T1时心率明显升高，平均动脉压、心输出量指数、每搏输出量指数明显降低，T4—T3时平均动脉压、心输出量指数、每搏输出量指数、总外周阻力指数明显升高；10Hz组T1—T0时平均动脉压、心输出量指数、每搏输出量指数、总外周阻力指数明显下降，T2—T1时心率明显降低；20Hz组T1—T0时心率明显升高，平均动脉压、心输出量指数、每搏输出量指数、总外周阻力指数明显降低，T2—T1时心率明显下降，总外周阻力指数明显升高。差异有显著性意义。 结论：全身振动治疗可以有效改善脊髓损伤恢复期患者体位变化的血流动力学变化和体位不耐受症状，是一种安全、有效改善脊髓损伤恢复期患者体位不耐受的物理治疗方法。

Abstract:

      Abstract Objective： To explore the physiological effects of whole body vibration therapy with different frequencies on the orthostatic tolerance of patients with chronic spinal cord injury. Method： Twenty one patients with spinal cord injury (with motor complete injury levels T6 and above；grade A or B on ASIA impairment scale；≥3 months post-injury)(group A) and 20 able-bodied individuals (group B) were recruited. Subjects completed 3 sessions. Non-invasive hemodynamic monitoring and OHSA evaluation were performed before and after the treatment when subjects changed their body position (supine， 60° standing， 3mins WBV treatment， 3mins after WBV， supine). Result： Compared with 0Hz， the HR and OHSA scores of 10Hz and 20Hz groups at T2， T3 and T4 were significantly lower. And the MAP and CI were significantly increased at T2 and T3 while the SVI increased significantly at T2. Besides， the TPRI were significantly increased at T2 and T3 in 20Hz group. Compared with the control group， the MAP， CI and SVI were significantly decreased at T1-T0， and the HR were significantly increased at T2-T1 while the MAP， CI and SVI were significantly decreased and the MAP， CI， SVI， TPRI were significantly increased at T4-T3 in 0Hz group. Meanwhile， the MAP， CI， SVI and TPRI decreased significantly at T1-T0 and the HR decreased significantly at T2-T1 in 10Hz group. In 20Hz group， the HR increased significantly and the MAP， CI， SVI， TPRI decreased significantly at T1-T0. However， the HR decreased significantly while the TPRI increased significantly at T2-T1. Conclusion： WBV can effectively improve the symptoms of postural intolerance in patients with chronic spinal cord injury. It is a safe and effective physical therapy method for improving postural intolerance in patients with chronic spinal cord injury.