Partida Elizabeth, Mironets Eugene, Hou Shaoping, Tom Veronica J
Spinal Cord Research Center, Department of Neurobiology & Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA.
Neural Regen Res. 2016 Feb;11(2):189-94. doi: 10.4103/1673-5374.177707.
Both sensorimotor and autonomic dysfunctions often occur after spinal cord injury (SCI). Particularly, a high thoracic or cervical SCI interrupts supraspinal vasomotor pathways and results in disordered hemodynamics due to deregulated sympathetic outflow. As a result of the reduced sympathetic activity, patients with SCI may experience hypotension, cardiac dysrhythmias, and hypothermia post-injury. In the chronic phase, changes within the CNS and blood vessels lead to orthostatic hypotension and life-threatening autonomic dysreflexia (AD). AD is characterized by an episodic, massive sympathetic discharge that causes severe hypertension associated with bradycardia. The syndrome is often triggered by unpleasant visceral or sensory stimuli below the injury level. Currently the only treatments are palliative - once a stimulus elicits AD, pharmacological vasodilators are administered to help reduce the spike in arterial blood pressure. However, a more effective means would be to mitigate AD development by attenuating contributing mechanisms, such as the reorganization of intraspinal circuits below the level of injury. A better understanding of the neuropathophysiology underlying cardiovascular dysfunction after SCI is essential to better develop novel therapeutic approaches to restore hemodynamic performance.
感觉运动和自主神经功能障碍常在脊髓损伤（SCI）后出现。特别是，高位胸椎或颈椎脊髓损伤会中断脊髓上血管运动通路，并由于交感神经输出失调而导致血流动力学紊乱。由于交感神经活动减弱，脊髓损伤患者在受伤后可能会出现低血压、心律失常和体温过低。在慢性期，中枢神经系统和血管内的变化会导致体位性低血压和危及生命的自主神经反射异常（AD）。自主神经反射异常的特征是阵发性大量交感神经放电，导致与心动过缓相关的严重高血压。该综合征通常由损伤水平以下的不愉快内脏或感觉刺激引发。目前唯一的治疗方法是姑息治疗——一旦刺激引发自主神经反射异常，就使用血管扩张药来帮助降低动脉血压峰值。然而，更有效的方法是通过减弱相关机制，如损伤水平以下脊髓内回路的重组，来减轻自主神经反射异常的发展。更好地理解脊髓损伤后心血管功能障碍的神经病理生理学对于更好地开发恢复血流动力学性能的新治疗方法至关重要。
