Wijnen Viona J M, Heutink Matagne, van Boxtel Geert J M, Eilander Henk J, de Gelder Beatrice
Cognitive Neuroscience Laboratory, Department of Psychology and Health, Tilburg University, Warandelaan 2, p.o. Box 90153, 5000 LE, Tilburg, The Netherlands.
Clin Neurophysiol. 2006 Aug;117(8):1794-807. doi: 10.1016/j.clinph.2006.03.006. Epub 2006 Jun 21.
To examine changes in the activity of the autonomic nervous system (ANS) that are related to recovery to consciousness in the post-acute phase after severe traumatic brain injury (sTBI).
Skin conductance and heart rate reactivity to sensory stimulation were recorded every 2 weeks for an average period of 3.5 months in 16 adolescent patients, during the assessment of their level of consciousness (LoC), and their cognitive and functional behaviour.
Both heart rate variability (HRV) and skin conductance level (SCL) in reaction to sensory stimulation changed with recovery to consciousness. Indices of HRV and SCL that represent sympathetic activity of the autonomic nervous system (ANS) increased with recovery, whereas indices that represent parasympathetic activity decreased. In addition, we observed an increase in sympathovagal balance of the ANS with recovery.
Recovery to consciousness determined by clinical observation in sTBI in the post-acute phase is related to changes in SCL and HRV during sensory stimulation. ANS reactivity to environmental stimulation can therefore give objective supplementary information about the clinical state of sTBI patients, and can contribute to decision-making in the treatment policy of unresponsive patients.
These findings demonstrate that autonomic reactivity can be informative concerning how a severely damaged nervous system reacts to environmental stimulation and how, in a recovering nervous system, this reactivity changes.
研究严重创伤性脑损伤（sTBI）后急性期自主神经系统（ANS）活动与意识恢复之间的关系。
对16例青少年患者，在评估其意识水平（LoC）、认知和功能行为期间，每2周记录一次对感觉刺激的皮肤电导率和心率反应，平均记录3.5个月。
随着意识恢复，对感觉刺激的心率变异性（HRV）和皮肤电导水平（SCL）均发生变化。代表自主神经系统（ANS）交感神经活动的HRV和SCL指标随恢复而增加，而代表副交感神经活动的指标则下降。此外，我们观察到随着恢复，ANS的交感迷走神经平衡增加。
在sTBI后急性期通过临床观察确定的意识恢复与感觉刺激期间SCL和HRV的变化有关。因此，ANS对环境刺激的反应性可为sTBI患者的临床状态提供客观补充信息，并有助于无反应患者治疗策略的决策。
这些发现表明，自主反应性对于严重受损的神经系统如何对环境刺激作出反应以及在恢复中的神经系统中这种反应性如何变化具有参考价值。
