aDivision of Critical Care, Department of Anesthesiology, Vanderbilt University Medical Center bDepartment of Anesthesiology, Critical Care, Tennessee Valley Healthcare System cDivision of Critical Care, Department of Anesthesiology, Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
Curr Opin Anaesthesiol. 2014 Jun;27(3):365-70. doi: 10.1097/ACO.0000000000000072.
The autonomic nervous system functions to control heart rate, blood pressure, respiratory rate, gastrointestinal motility, hormone release, and body temperature on a second-to-second basis. Here we summarize some of the latest literature on autonomic dysfunction, focusing primarily on the perioperative implications.
The variety of autonomic dysfunction now extends to a large number of clinical conditions in which the cause or effect of the autonomic component is blurred. Methods for detecting dysautonomia can be as simple as performing a history and physical examination that includes orthostatic vital signs measured in both recumbent and vertical positions; however, specialized laboratories are required for definitive diagnosis. Heart rate variability monitoring is becoming more commonplace in the assessment and understanding of autonomic instability. Degenerative diseases of the autonomic nervous system include Parkinson's disease and multiple system atrophy, with the most serious manifestations being postural hypotension and paradoxical supine hypertension. Other conditions occur in which the autonomic dysfunction is only part of a larger disease process, such as diabetic autonomic neuropathy, traumatic brain injury, and spinal cord injury.
Patients with dysautonomia often have unpredictable and paradoxical physiological responses to various perioperative stimuli. Knowledge of the underlying pathophysiology of their condition is required in order to reduce symptom exacerbation and limit morbidity and mortality during the perioperative period.
自主神经系统的功能是在秒级基础上控制心率、血压、呼吸频率、胃肠蠕动、激素释放和体温。本文总结了一些关于自主神经功能障碍的最新文献，主要关注围手术期的影响。
自主神经功能障碍的种类现在已经扩展到许多临床情况下，其中自主成分的原因或影响变得模糊不清。检测自主神经病变的方法可以像进行病史和体检一样简单，包括在卧位和垂直位测量直立生命体征；然而，需要专门的实验室来进行明确的诊断。心率变异性监测在评估和理解自主不稳定方面变得越来越普遍。自主神经系统的退行性疾病包括帕金森病和多系统萎缩，最严重的表现是体位性低血压和反常仰卧位高血压。其他情况下，自主神经功能障碍只是更大疾病过程的一部分，如糖尿病自主神经病变、创伤性脑损伤和脊髓损伤。
自主神经功能障碍的患者在接受各种围手术期刺激时，常常会出现不可预测和反常的生理反应。为了减少症状恶化并限制围手术期的发病率和死亡率，需要了解其潜在的病理生理学。
