Malmqvist L, Biering-Sørensen T, Bartholdy K, Krassioukov A, Welling K-L, Svendsen J H, Kruse A, Hansen B, Biering-Sørensen F
1] Department of Spinal Cord Injuries, Glostrup hospital/Rigshospitalet 2081, Copenhagen, Denmark [2] Department of Clinical Neurophysiology, Rigshopitalet, Copenhagen, Denmark.
1] Department of Spinal Cord Injuries, Glostrup hospital/Rigshospitalet 2081, Copenhagen, Denmark [2] Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark [3] Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark.
Spinal Cord. 2015 Jan;53(1):54-8. doi: 10.1038/sc.2014.195. Epub 2014 Nov 18.
Spinal cord injury (SCI) often results in severe dysfunction of the autonomic nervous system. C1-C8 SCI affects the supraspinal control to the heart, T1-T5 SCI affects the spinal sympathetic outflow to the heart, and T6-T12 SCI leaves sympathetic control to the heart intact. Heart rate variability (HRV) analysis can serve as a surrogate measure of autonomic regulation. The aim of this study was to investigate changes in HRV patterns and alterations in patients with acute traumatic SCI.
As soon as possible after SCI patients who met the inclusion criteria had 24 h Holter monitoring of their cardiac rhythm, additional Holter monitoring were performed 1, 2, 3 and 4 weeks after SCI.
Fifty SCI patients were included. A significant increase in standard deviation of the average normal-to-normal (SDANN) sinus intervals was seen in the first month after injury (P=0.008). The increase was only significant in C1-T5 incomplete patients and in patients who did not experience one or more episodes of cardiac arrest. Significant lower values of Low Frequency Power, Total Power and the Low Frequency over High Frequency ratio were seen in the C1-T5 SCI patients compared with T6-T12 SCI patients.
The rise in SDANN in the incomplete C1-T5 patients could be due to spontaneous functional recovery caused by synaptic plasticity or remodelling of damaged axons. That the autonomic nervous system function differs between C1-C8, T1-T5 and T6-T12 patients suggest that the sympathovagal balance in both the C1-C8 and T1-T5 SCI patients has yet to be reached.
脊髓损伤（SCI）常导致自主神经系统严重功能障碍。C1 - C8脊髓损伤影响心脏的脊髓上控制，T1 - T5脊髓损伤影响心脏的脊髓交感神经输出，而T6 - T12脊髓损伤使心脏的交感神经控制保持完整。心率变异性（HRV）分析可作为自主神经调节的替代指标。本研究旨在调查急性创伤性脊髓损伤患者HRV模式的变化及改变情况。
符合纳入标准的脊髓损伤患者在受伤后尽快进行24小时动态心电图监测心律，在脊髓损伤后1、2、3和4周进行额外的动态心电图监测。
纳入50例脊髓损伤患者。损伤后第一个月平均正常到正常（SDANN）窦性间期的标准差显著增加（P = 0.008）。这种增加仅在C1 - T5不完全损伤患者和未经历一次或多次心脏骤停发作的患者中显著。与T6 - T12脊髓损伤患者相比，C1 - T5脊髓损伤患者的低频功率、总功率和低频与高频比值显著降低。
C1 - T5不完全损伤患者SDANN的升高可能是由于突触可塑性或受损轴突重塑导致的自发功能恢复。C1 - C8、T1 - T5和T6 - T12患者自主神经系统功能不同，这表明C1 - C8和T1 - T5脊髓损伤患者的交感迷走神经平衡尚未达到。
