Assessment of Jugular Venous Blood FlowStasis and Thrombosis During Spaceflight

被引：199

作者：

Marshall-Goebel, Karina ^{[1
]}

Laurie, Steven S. ^{[1
]}

Alferova, Irina V. ^{[2
]}

Arbeille, Philippe ^{[3
]}

Aunon-Chancellor, Serena M. ^{[4
]}

Ebert, Douglas J. ^{[1
]}

Lee, Stuart M. C. ^{[1
]}

Macias, Brandon R. ^{[1
]}

Martin, David S. ^{[1
]}

Pattarini, James M. ^{[4
]}

Ploutz-Snyder, Robert ^{[5
]}

Ribeiro, L. Christine ^{[1
]}

Tarver, William J. ^{[4
]}

Dulchavsky, Scott A. ^{[6
]}

Hargens, Alan R. ^{[7
]}

Stenger, Michael B. ^{[4
]}

机构：

[1] KBR, Houston, TX USA

[2] Russian Acad Sci, Inst Biomed Problems, Moscow, Russia

[3] Univ Hosp Trousseau, Tours, France

[4] NASA, Johnson Space Ctr, 2101 E NASA Pkwy, Houston, TX 77058 USA

[5] Univ Michigan, Sch Nursing, Appl Biostat Lab, Ann Arbor, MI 48109 USA

[6] Henry Ford Hosp, Dept Surg, Detroit, MI 48202 USA

[7] Univ Calif San Diego, Dept Orthopaed Surg, UC San Diego Med Ctr, San Diego, CA 92103 USA

来源：

JAMA NETWORK OPEN | 2019年 / 2卷 / 11期

基金：

美国国家航空航天局;

关键词：

FLUID SHIFTS; RISK-FACTORS; SHORT-TERM; VEIN; MICROGRAVITY;

D O I：

10.1001/jamanetworkopen.2019.15011

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

IMPORTANCE Exposure to a weightless environment during spaceflight results in a chronic headward blood and tissue fluid shift compared with the upright posture on Earth, with unknown consequences to cerebral venous outflow. OBJECTIVES To assess internal jugular vein (IJV) flow and morphology during spaceflight and to investigate if lower body negative pressure is associated with reversing the headward fluid shift experienced during spaceflight. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 11 International Space Station crew members participating in long-duration spaceflight missions. Internal jugular vein measurements from before launch and approximately 40 days after landing were acquired in 3 positions: seated, supine, and 15 degrees head-down tilt. In-flight IJV measurements were acquired at approximately 50 days and 150 days into spaceflight during normal spaceflight conditions as well as during use of lower body negative pressure. Data were analyzed in June 2019. EXPOSURES Posture changes on Earth, spaceflight, and lower body negative pressure. MAIN OUTCOMES AND MEASURES Ultrasonographic assessments of IJV cross-sectional area, pressure, blood flow, and thrombus formation. RESULTS The 11 healthy crew members included in the study (mean [SD] age, 46.9 [6.3] years, 9 [82%] men) spent a mean (SD) of 210 (76) days in space. Mean IJV area increased from 9.8 (95% CI, -1.2 to 20.7) mm(2) in the preflight seated position to 70.3 (95% CI, 59.3-81.2) mm(2) during spaceflight (P < .001). Mean IJV pressure increased from the preflight seated position measurement of 5.1 (95% CI, 2.5-7.8) mm Hg to 21.1 (95% CI, 18.5-23.7) mm Hg during spaceflight (P < .001). Furthermore, stagnant or reverse flow in the IJV was observed in 6 crew members (55%) on approximate flight day 50. Notably, 1 crew member was found to have an occlusive IJV thrombus, and a potential partial IJV thrombus was identified in another crew member retrospectively. Lower body negative pressure was associated with improved blood flow in 10 of 17 sessions (59%) during spaceflight. CONCLUSIONS AND RELEVANCE This cohort study found stagnant and retrograde blood flow associated with spaceflight in the IJVs of astronauts and IJV thrombosis in at least 1 astronaut, a newly discovered risk associated with spaceflight. Lower body negative pressure may be a promising countermeasure to enhance venous blood flow in the upper body during spaceflight.

引用

页数：11

共 31 条

[1] Adaptation of the left heart, cerebral and femoral arteries, and jugular and femoral veins during short- and long-term head-down tilt and spaceflights [J].