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直立性低血压的机制、病因和评估

Authors
Horacio Kaufmann, MD
Norman M Kaplan, MD
Section Editor
Michael J Aminoff, MD, DSc
Deputy Editor
Janet L Wilterdink, MD
Translators
韩劲松, 副主任医师

引言

当自主神经反射受损或血管内容量明显不足，在直立时发生血压显著下降，这种现象称为直立性低血压。直立性低血压可引起头晕、晕厥，甚至心绞痛或脑卒中。

站立或进食后出现有症状的血压下降是一个常见的临床问题。不同报告中直立性低血压的患病率各有不同，在5%-20%之间。许多疾病可以引起直立性低血压，后者也可以是急性或慢性容量不足的症状以及药物(尤其是降压药)的副作用。一个相关的问题，餐后低血压(餐后15-90min出现血压下降)在较年长个体中也很常见。

慢性直立不耐受(chronic orthostatic intolerance, COI)描述的是发生与长时间站立或直立姿势相关的头晕目眩、头晕、昏眩或晕厥。有时这些症状伴发心动过速加重，但血压很少降低或不下降，这种疾病称为体位性心动过速综合征(postural tachycardia syndrome, POTS)。

本专题将总结直立性和餐后低血压的发病机制和病因。其治疗将单独讨论。POTS也将单独讨论(参见“直立和餐后低血压的治疗”和“体位性心动过速综合征”)。

对站立的正常血压反应

直立姿势使500-1000mL的血液聚集在下肢和内脏循环，引起下列变化依次发生[1]：

                    

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Literature review current through: 2017-06 . | This topic last updated: 2015-02-02.
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