Janitzki A, Götte A
Fachgebiet Nachrichtentechnik, Universität Paderborn.
Reg Anaesth. 1990 May;13(3):91-4.
The activity of the sympathetic nervous system is of fundamental importance in the regulation of vital bodily functions. Impairment of sympathetic neuronal efferences results in considerably disordered effector function, and in some cases even in complete failure. Clinically, this is of great significance, because if an anesthetic agent produces cause the sympathetic system to block, the effects can be serious in individual cases, particularly on the cardiovascular system. If complications are to be avoided, it is essential to assess the degree of block correctly. Clinical monitoring has a variety of applications, a particularly useful one being measurement of the sympathetic system during regional anesthesia, for which quantification of the blocking effect is a clinical necessity and the degree of block needs to be ascertained without delay, for example in the case of spinal or peridural anesthesia. The activity of the sympathetic system can be monitored indirectly by two means: by measuring changes in skin temperature (with reference to all circulatory parameters), as these reflect its influence on the arterioles, and by measuring the skin resistance caused by the eccrinal sweat glands, which are also regulated by the sympathetic system. As the anatomical and functional structure of the system is highly complex a connection between the two measurements cannot necessarily be assumed. The two variables were measured simultaneously during spinal anesthesia and analysed. It was shown that the two measurements correlated well, at least in the statistical middle range, and that skin resistance was by far the faster and more sensitive of the two.
交感神经系统的活动在调节人体重要生理功能方面至关重要。交感神经元传出功能受损会导致效应器功能严重紊乱,在某些情况下甚至会完全失效。在临床上,这具有重大意义,因为如果麻醉剂导致交感神经系统阻滞,个别情况下后果可能很严重,尤其是对心血管系统。若要避免并发症,正确评估阻滞程度至关重要。临床监测有多种应用,其中特别有用的一种是在区域麻醉期间对交感神经系统进行测量,对于这种情况,阻滞效果的量化是临床必需的,而且需要立即确定阻滞程度,例如在脊髓或硬膜外麻醉的情况下。交感神经系统的活动可以通过两种方式间接监测:通过测量皮肤温度的变化(参考所有循环参数),因为这些变化反映了其对小动脉的影响;以及通过测量由交感神经系统调节的汗腺引起的皮肤电阻。由于该系统的解剖和功能结构高度复杂,不一定能假定这两种测量之间存在关联。在脊髓麻醉期间同时测量了这两个变量并进行了分析。结果表明,至少在统计中间范围内,这两种测量结果相关性良好,而且皮肤电阻是两者中速度更快、更敏感的。