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ID naloge: 135 Letnik: 2003 Predmet: nevrologija
VPLIV ANKSIOLITIKA NA KVALITETO ŽIVLJENJA IN NA KARDIOVASKULARNO AVTONOMNO FUNKCIJO PRI BOLNIKU S POSTURALNO ORTOSTATSKO TAHIKARDIJO
Avtor: Amer Beharic, Niko Kavcic
Mentor: prof. dr. Anton Grad
Somentor: asist. mag. Bernard Meglic
IZHODIŠCE: Sindrom posturalne ortostatske tahikardije (POTS) je motnja v delovanju avtonomnega živcnega sistema. Najverjetnejša patofiziološka osnova je prizadetost adrenergicnih in kardiovagalnih živcnih vlaken ter dolocene motnje centralnega živcnega sistema. Pri vstajanju ali testu z nagibno mizo pri teh bolnikih prekomerno poraste srcni ritem, vendar obicajno ne pride do padca krvnega tlaka. Od simptomov se pojavijo omotica, palpitacije, sinkopa, anksioznost. Bolniki imajo znižano kvaliteto življenja z omejitvami na vecih podrocjih življenja.
NAMEN: Zdravljenje POTS je nedoreceno. Pogosto predpisano zdravilo je anksiolitik. Predpisovanje slednjega ima poleg empiricne tudi možno patofiziološko podlago, saj je eden izmed centralnih mehanizmov za razvoj tahikardije z ortostatsko intoleranco stres, oziroma anksioznost, oziroma hiperventilacija. Namen najine naloge je bil ugotoviti smotrnost uporabe anksiolitika pri bolnikih s POTS.
HIPOTEZA: Jemanje anksiolitika pri bolnikih s POTS izboljša kvaliteto življenja, omili simptome ortostatske intolerance in zmanjša motnje v delovanju avtonomnega živcevja.
METODE: Raziskavo smo zasnovali kot prospektivno študijo na ljudeh. Iz arhiva nevrokardiološkega laboratorija sva izbrala bolnike, ki so pri testu z nagibno mizo imeli prekomeren porast srcnega utripa in ob tem simptome ortostatske intolerance. Bolniki so izpolnili vprašalnik SF-36, ki ocenjuje kvaliteto življenja in vprašalnik ASP, ki ocenjuje težavnost in pogostnost avtonomnih simptomov. Nato smo merili krvni tlak in srcni ritem med mirovanjem, globokim dihanjem, Valsalvinim manevrom, omocitvijo obraza in testom z nagibno mizo ter izracunali parametre za oceno delovanja avtonomnega živcevja. Po štirih do petih tednih jemanja alprazolama smo na enajstih bolnikih ponovili celotno testiranje, vkljucno z izpolnjevanjem vprašalnika. Dobljene podatke pred in po jemanju zdravila smo obdelali z neparametricnim Wilcoxonovim parnim testom.
REZULTATI: Pri bolnikih pred in po jemanju alprazolama nismo ugotovili statisticno znacilne razlike v kvaliteti življenja. Podobno ni bilo statisticno znacilne razlike pri navajanju ortostatskih simptomov. Preiskovanci se pred in po jemanju alprazolama niso pomembno razlikovali glede rezultatov testiranja delovanja avtonomnega živcevja.
ZAKLJUCKI: Na osnovi rezultatov sva v celoti zavrnila hipotezo. Rezultati kažejo, da jemanje anksiolitika pri bolnikih s POTS ne izboljša kvalitete življenja, ne omili simptomov ortostatske intolerance in ne zmanjša motnje v delovanju avtonomnega živcevja. Izhajajoc iz rezultatov najine raziskave zakljucujeva, da anksioznost sama po sebi ne predstavlja pomembnejšega dejavnika v etiopatogenezi POTS.
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[Abstract / English version]
VPLIV ANKSIOLITIKA NA KVALITETO ŽIVLJENJA IN NA KARDIOVASKULARNO AVTONOMNO FUNKCIJO PRI BOLNIKU S POSTURALNO ORTOSTATSKO TAHIKARDIJO
Author: Amer Beharic, Niko Kavcic
Mentor: prof. dr. Anton Grad
Co-mentor: asist. mag. Bernard Meglic
BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system. The pathology is characterized by adrenergic and cardiovagal nerve fibre dysfunction, combined with central abnormality in autonomic regulation. When assuming the upright posture or performing the tilt table testing the patients develop excessive tachycardia and symptoms like dizziness, syncope, palpitations, anxiety. These symptoms are often present in the absence of any decrease in arterial pressure. Patients with POTS experience limitations in multiple domains of quality of life.
AIM: A variety of approaches have been used to alleviate symptoms in POTS, including anxiolytic therapy. Among central mechanisms, stress, anxiety, and hyperventilation are factors that can trigger tachycardia with orthostatic intolerance. Thus the prescription of anxiolytics might also have a pathophysiologic fundament. The aim of the present work was to investigate the efficacy of anxiolytic therapy in patients with POTS.
HYPOTHESIS: Anxiolytic therapy improves quality of life, decreases symptoms of orthostatic intolerance and normalizes autonomic abnormalities.
METHODS: We implemented the research as a prospective study on human subjects. Patients were selected from the archive of the neurocardiologic laboratory on the basis of orthostatic tachycardia and orthostatic intolerance development upon tilt testing. Patients completed a questionnaire packet that included measures of quality of life (SF-36) and autonomic symptom severity (ASP). To evaluate autonomic nervous system function we monitored blood pressure and the ECG during rest, deep breathing, Valsalva maneuver, cold face test and tilt table testing. After alprazolam therapy for four to five weeks eleven patients were surveyed and tested again. Data obtained before and after treatment were analysed statistically with non-parametric Wilcoxon paired test.
RESULTS: Patients before and after alprazolam therapy did not significantly differ in the quality of life. Similarly there was no statistically significant difference in the severity of autonomic symptoms. Autonomic function test results of the patients remained unchanged after the therapy with alprazolam.
CONCLUSIONS: The hypothesis was rejected. The results show that anxiolytic therapy in patients with POTS does not improve quality of life, does not decrease symptoms of orthostatic intolerance and does not normalize autonomic abnormalities. The results also indicate that anxiety does not play a major role in the pathophysiology of the disease.
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