Division of Physical Medicine and Rehabilitation, Department of Medicine, International Collaboration on Repair Discoveries, University of British Columbia, and GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
Clin J Sport Med. 2012 Jan;22(1):39-45. doi: 10.1097/JSM.0b013e3182420699.
To present the complex issues of the impact of spinal cord injury (SCI) in sport, with a specific focus on autonomic dysreflexia (AD) and the potential debilitating effects of unstable blood pressure control among athletes.
A literature review based on a key word electronic literature search of articles, practice guidelines, and review articles pertaining to AD was conducted using MEDLINE, SportDiscus, and EMBASE.
Spinal cord injury results not only in devastating paralysis; it also commonly is associated with a range of autonomic dysregulation that can interfere with cardiovascular, bladder, bowel, temperature, and sexual function. Individuals with a cervical or high-thoracic SCI face lifelong abnormalities in systemic arterial pressure control. In general, their resting arterial pressure is lower than that in able-bodied individuals and is commonly associated with persistent orthostatic intolerance. In addition, they experience transient episodes of life-threatening hypertension, known as "AD," which often is associated with disturbances in heart rate and rhythm. Autonomic dysreflexia occurs in up to 90% of individuals with a cervical or high-thoracic SCI and requires prompt intervention. It also is known that, during athletic activities, self-induced AD is used by some individuals to improve their performance, a technique known as "boosting." For health safety reasons, boosting is officially banned by the International Paralympic Committee.
Devastating paralysis, a variety of autonomic dysfunctions, and abnormal cardiovascular control after SCI present significant challenges in terms of individuals remaining active in competitive sports. Medical practitioners who are involved in the care of wheelchair athletes should be aware of the unique cardiovascular dysfunction that results from SCI and may occur at any time, even with seemingly innocuous triggers. Prompt recognition and appropriate management of these conditions, including episodes of AD, could be life saving.
介绍脊髓损伤（SCI）对运动的影响所涉及的复杂问题，特别关注自主反射异常（AD）以及运动员血压控制不稳定可能带来的潜在致残影响。
采用 MEDLINE、SportDiscus 和 EMBASE 等电子文献数据库，以 AD 为关键词，对相关文章、实践指南和综述进行文献回顾。
SCI 不仅导致严重瘫痪，还常伴有一系列自主神经功能紊乱，从而影响心血管、膀胱、肠道、体温和性功能。颈髓或胸髓以上 SCI 患者终身存在系统性动脉血压控制异常。一般来说，他们的静息动脉压低于健全人，且常伴有持续的直立不耐受。此外，他们还会出现危及生命的短暂高血压发作，即“AD”，常伴有心率和节律紊乱。高达 90%的颈髓或胸髓以上 SCI 患者会发生自主反射异常，需要及时干预。此外，一些运动员在运动过程中会自我诱发 AD 来提高运动成绩，这种技术被称为“升压”。出于健康安全考虑，国际残奥会委员会正式禁止升压。
SCI 导致的严重瘫痪、多种自主功能障碍和心血管控制异常，给运动员参与竞技体育带来了巨大挑战。参与轮椅运动员护理的医务人员应了解 SCI 导致的独特心血管功能障碍，这种障碍可能随时发生，即使是看似无害的诱因也可能引发。及时识别和适当管理这些病症，包括 AD 发作，可能挽救生命。
