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Systemic and cerebral circulatory adjustment within the first 60 s after active standing: An integrative physiological view
Autonomic Neuroscience ( IF 2.7 ) Pub Date : 2021-03-01 , DOI: 10.1016/j.autneu.2020.102756
Mark P M Harms 1 , Ciáran Finucane 2 , Laura Pérez-Denia 2 , Stephen P Juraschek 3 , Veera K van Wijnen 1 , Lewis A Lipsitz 4 , Johannes J van Lieshout 5 , Wouter Wieling 6
Affiliation  

Transient cardiovascular and cerebrovascular responses within the first minute of active standing provide the means to assess autonomic, cardiovascular and cerebrovascular regulation using a real-world everyday stimulus. Traditionally, these responses have been used to detect autonomic dysfunction, and to identify the hemodynamic correlates of patient symptoms and attributable causes of (pre)syncope and falls. This review addresses the physiology of systemic and cerebrovascular adjustment within the first 60 s after active standing. Mechanical factors induced by standing up cause a temporal mismatch between cardiac output and vascular conductance which leads to an initial blood pressure drops with a nadir around 10 s. The arterial baroreflex counteracts these initial blood pressure drops, but needs 2-3 s to be initiated with a maximal effect occurring at 10 s after standing while, in parallel, cerebral autoregulation buffers these changes within 10 s to maintain adequate cerebral perfusion. Interestingly, both the magnitude of the initial drop and these compensatory mechanisms are thought to be quite well-preserved in healthy aging. It is hoped that the present review serves as a reference for future pathophysiological investigations and epidemiological studies. Further experimental research is needed to unravel the causal mechanisms underlying the emergence of symptoms and relationship with aging and adverse outcomes in variants of orthostatic hypotension.

中文翻译:

主动站立后 60 秒内的全身和脑循环调节:综合生理学观点

主动站立第一分钟内的短暂心血管和脑血管反应提供了使用真实世界的日常刺激来评估自主神经、心血管和脑血管调节的方法。传统上,这些反应被用来检测自主神经功能障碍,并确定患者症状的血流动力学相关性以及(前)晕厥和跌倒的归因原因。这篇综述讨论了主动站立后 60 秒内全身和脑血管调节的生理学。站立引起的机械因素会导致心输出量和血管电导之间的时间不匹配,从而导致初始血压下降,并在 10 秒左右达到最低点。动脉压力感受反射抵消了这些最初的血压下降,但需要 2-3 秒才能启动,在站立后 10 秒时产生最大效果,同时,大脑自动调节在 10 秒内缓冲这些变化,以维持足够的脑灌注。有趣的是,最初下降的幅度和这些补偿机制被认为在健康衰老过程中得到了很好的保存。希望本综述能为今后的病理生理学调查和流行病学研究提供参考。需要进一步的实验研究来揭示症状出现的因果机制以及与衰老和体位性低血压变体不良后果的关系。
更新日期:2021-03-01
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