Wang Y H, Huang T S, Lin J L, Hwang J J, Chan H L, Lai J S, Tseng Y Z
Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei.
Arch Phys Med Rehabil. 2000 Sep;81(9):1181-4. doi: 10.1053/apmr.2000.6300.
To assess the alterations of autonomic nervous functions and sympathovagal balance of the subjects with spinal cord injuries (SCIs) in different levels by heart rate variability analysis.
Prospective, observational study.
All participants were recruited from the outpatient clinic from National Taiwan University Hospital, which is a tertiary referral center.
Thirty-one patients with traumatic chronic complete SCI (more than 6 months): 14 with paraplegia (Group A), and 17 with tetraplegia (Group B).
Heart rate variability assessed by 24-hour Holter monitoring.
Two patients in Group A and 1 in Group B were excluded from final data analysis because of poor recording data. Two time domain variables, the standard deviation (SD) of all normal RR intervals (SDNN) and the mean of the SDs of all normal RR intervals for all 5-minute intervals (SDNNi), over 24 hours were decreased in Group B. All time domain variables, SDNN, SDNNi, root mean square of the successive normal RR interval difference (rMSSD), and the percentage of RR intervals differing >50msec from the preceding one (pNN50), were decreased during the nighttime recordings (all p < .05) in Group B. The very-low-frequency, low-frequency (LF), and high-frequency (HF) components of the power spectrum of the RR intervals were also decreased in Group B (p < .05), irrespective of the daytime and nighttime recordings. The LF-to-HF ratio did not differ significantly in these two groups, indicating the maintained sympathovagal balance in the chronic SCI patients.
These findings suggested that the autonomic nervous system activity was depressed in the patients with chronic tetraplegia, but the autonomic nervous system still maintained homeostasis.
通过心率变异性分析评估不同节段脊髓损伤（SCI）患者自主神经功能及交感-迷走神经平衡的改变。
前瞻性观察性研究。
所有参与者均来自台湾大学医院门诊，该医院为三级转诊中心。
31例创伤性慢性完全性SCI患者（病程超过6个月）：14例截瘫患者（A组），17例四肢瘫患者（B组）。
通过24小时动态心电图监测评估心率变异性。
A组2例患者和B组1例患者因记录数据不佳被排除在最终数据分析之外。B组24小时内两个时域变量，即所有正常RR间期的标准差（SDNN）和所有5分钟间期内所有正常RR间期标准差的平均值（SDNNi）均降低。B组夜间记录时所有时域变量，SDNN、SDNNi、相邻正常RR间期差值的均方根（rMSSD）以及RR间期与前一个RR间期差值>50毫秒的百分比（pNN50）均降低（均p<0.05）。B组RR间期功率谱的极低频、低频（LF）和高频（HF）成分也降低（p<0.05），无论白天还是夜间记录。两组的LF/HF比值无显著差异，表明慢性SCI患者的交感-迷走神经平衡得以维持。
这些发现提示慢性四肢瘫患者的自主神经系统活动受到抑制，但自主神经系统仍维持稳态。
