■关于运动中脑震荡的第六次国际共识声明指南确定,使用体位生命体征(VS)测量自主神经系统功能障碍是临床评估的重要组成部分;但是,关于脑震荡后通过体位性VSs捕获的自主神经系统功能障碍频率的数据有限。
■要比较心率(HR)的体位变化,收缩压(SBP),急性运动相关脑震荡(SRC)运动员和对照运动员之间的舒张压(DBP)。
■横断面研究;证据水平,3.
■我们比较了133名运动员(平均年龄,15.3岁;年龄范围,8-28岁;45.9%女性)急性SRC(受伤后<30天),100名对照运动员(平均年龄,15.7岁;年龄范围,10-28岁;54.0%为女性)。鉴于有资格纳入研究的广泛年龄范围,参与者被细分为儿童(年龄小于13岁),青少年(13-17岁),和成人(18岁及以上)年龄组进行亚分析。参与者完成了包括HR在内的单一标准立位VS评估,SBP,和DBP在仰卧位,然后立即和2分钟后站立。线性回归用于比较HR的延迟仰卧至站立变化,SBP,和DBP作为连续变量(ΔHR,ΔSPB,和ΔDBP)组间,和logistic回归用于比较体位VS变化阳性的患者(持续HR增加≥30次/分钟[bpm],SBP下降≥20mmHg,和DBP≥10mmHg在2分钟)组间,考虑年龄和性别。
■延迟ΔHR(SRC患者为18.4±12.7bpm,对照组为13.2±11.0bpm;P=0.002)和ΔSPB(SRC患者为-3.1±6.6bpm,对照组为-0.4±6.5bpm;P=.001)存在组间差异,在SRC患者中,体位HR变化呈阳性(18%vs7%;比值比,2.79;P=.027)。在SRC组中,年龄与ΔHR之间存在微弱的反比关系(r=-0.171;P=0.049),立位HR阳性结果主要发生在儿童和青少年SRC亚组。
■与对照组相比,急性SRC患者的体位VS变化更大,最突出的是持续的HR升高。通过标准体位VS评估对SRC后自主神经改变的临床评估可能是评估SRC的有用临床生物标志物。尤其是儿童和青少年。
UNASSIGNED: The 6th International Consensus Statement on Concussion in Sport guidelines identified that measuring autonomic nervous system dysfunction using orthostatic vital signs (VSs) is an important part of the clinical evaluation; however, there are limited data on the frequency of autonomic nervous system dysfunction captured via orthostatic VSs after concussion.
UNASSIGNED: To compare orthostatic changes in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between athletes with acute sport-related concussion (SRC) and control athletes.
UNASSIGNED: Cross-sectional study; Level of evidence, 3.
UNASSIGNED: We compared 133 athletes (mean age, 15.3 years; age range, 8-28 years; 45.9% female) with acute SRC (<30 days after injury) with 100 control athletes (mean age, 15.7 years; age range, 10-28 years; 54.0% female). Given the broad age range eligible for study inclusion, participants were subdivided into child (younger than 13 years of age), adolescent (13-17 years of age), and adult (18 years of age and older) age groups for subanalyses. Participants completed a single standard orthostatic VS evaluation including HR, SBP, and DBP in the supine position then immediately and 2 minutes after standing. Linear regression was used to compare delayed supine-to-standing changes in HR, SBP, and DBP as a continuous variable (ΔHR, ΔSPB, and ΔDBP) between groups, and logistic regression was used to compare patients with positive orthostatic VS changes (sustained HR increase ≥30 beats per minute [bpm], SBP decrease ≥20 mm Hg, and DBP ≥10 mm Hg at 2 minutes) between groups, accounting for age and sex.
UNASSIGNED: Between-group differences were present for delayed ΔHR (18.4 ± 12.7 bpm in patients with SRC vs 13.2 ± 11.0 bpm in controls; P = .002) and ΔSPB (-3.1 ± 6.6 bpm in patients with SRC vs -0.4 ± 6.5 bpm in controls; P = .001), with positive orthostatic HR changes present more frequently in patients with SRC (18% vs 7%; odds ratio, 2.79; P = .027). In the SRC group, a weak inverse relationship was present between age and ΔHR (r = -0.171; P = .049), with positive orthostatic HR findings occurring primarily in the child and adolescent SRC subgroups.
UNASSIGNED: Patients with acute SRC had greater orthostatic VS changes compared with controls, the most prominent being sustained HR elevations. Clinical evaluation of autonomic change after SRC via standard orthostatic VS assessment may be a helpful clinical biomarker in the assessment of SRC, especially in children and adolescents.