Gradl Georg, Schürmann Matthias
Chirurgische Klinik und Poliklinik der Universität Rostock, Abteilung Unfall- und Wiederherstellungschirurgie, Rostock, Germany.
Clin Auton Res. 2005 Feb;15(1):29-34. doi: 10.1007/s10286-005-0237-z.
Sympathetic testing was carried out in patients in the acute phase of "complex regional pain syndrome type I" (CRPS I) shortly after trauma to the upper limb. Repeated measurements were used to detect changes in peripheral sympathetic function during the course of the disease.
In a busy trauma center, 10 consecutive patients who developed CRPS I following trauma or surgery of the upper limb were diagnosed according to the 1999 modified IASP diagnostic criteria for CRPS I. Clinical signs and symptoms and bilateral hand temperature (infrared thermometry) were recorded. Vasoconstrictor response to sympathetic provocation (inspiratory gasp, contralateral cooling) at the tip of the middle finger of both hands was measured employing laser Doppler flowmetry (LDF). Sympathetic reaction was quantified by the magnitude of blood flow decrease after provocation (SRF parameter).
The diagnosis CRPS I could be established 63 days (46-72 days) post-injury. The mean follow-up time after diagnosis was 83+/-15 days. Pain measured by a visual analog scale (VAS 0-10) showed an average of 5.0+/-2.0 at the time of diagnosis and decreased to 1.7+/-1.9 at the last examination. Edema and active range of motion improved substantially during the follow-up period. On the ipsilateral hand marked sympathetic dysfunction was seen early after the onset of CRPS I (mean SRF parameter: 0.14+/-0.01), slowly returning to normal sympathetic reaction three months after the onset of symptoms (mean SRF parameter: 0.42+/-0.21). Diminished sympathetic function was seen even on the contralateral hand.
Sympathetic dysfunction is regularly seen at the onset of CRPS I and normalizes during the course of the disease. This temporary phenomenon suggests a posttraumatic sympathetic deficit playing a decisive role in the genesis of CRPS I.
对上肢创伤后处于“复杂性区域疼痛综合征I型”（CRPS I）急性期的患者进行交感神经测试。采用重复测量来检测疾病过程中外周交感神经功能的变化。
在一家繁忙的创伤中心，根据1999年修订的IASP关于CRPS I的诊断标准，对10例上肢创伤或手术后发生CRPS I的连续患者进行诊断。记录临床体征和症状以及双侧手部温度（红外测温法）。采用激光多普勒血流仪（LDF）测量双手中指指尖对交感神经激发（吸气屏气、对侧冷却）的血管收缩反应。通过激发后血流减少的幅度（SRF参数）对交感神经反应进行量化。
受伤后63天（46 - 72天）可确诊为CRPS I。诊断后的平均随访时间为83±15天。通过视觉模拟量表（VAS 0 - 10）测量的疼痛在诊断时平均为5.0±2.0，在最后一次检查时降至1.7±1.9。随访期间水肿和活动范围显著改善。在CRPS I发病后早期，患侧手部可见明显的交感神经功能障碍（平均SRF参数：0.14±0.01），症状出现三个月后交感神经反应缓慢恢复正常（平均SRF参数：0.42±0.21）。甚至在对侧手部也可见交感神经功能减退。
CRPS I发病时经常出现交感神经功能障碍，且在疾病过程中恢复正常。这种暂时现象提示创伤后交感神经功能缺陷在CRPS I的发病机制中起决定性作用。
