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弹力袜对外周和中枢神经系统的影响。

Effects of elastic stockings on peripheral and central nervous system.

作者信息

Mancini Stefano, Mariani Fabrizio, Rossi Alessandro, Cioncoloni David, Ginanneschi Federica

机构信息

Unit of Phlebolymphology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.

European Training Center in Phlebology - European Union of Medical Specialists, Angiomedica Vein Clinic, Colle Val d'Elsa, Siena, Italy.

出版信息

Int Angiol. 2020 Apr;39(2):155-160. doi: 10.23736/S0392-9590.20.04223-6. Epub 2020 Feb 5.

Abstract

BACKGROUND

Prospective study to investigate the effects of elastic stockings (GCS) 23-32 mmHg at ankle on Hoffmann reflex (H-reflex) from soleus muscle under rest and after a walking program.

METHODS

Fourteen subjects wore two types of GCS, at different times. Electrophysiological examinations were carried out at rest without and with GCS, immediately after walking with GCS and 20 minutes later after removing GCS.

RESULTS

Peripheral nerve conduction remained unchanged after using the GCS. Conversely, walking with GCS led to changes in a spinal cord pathway expressed as a decrease of H-threshold and an increase of H-size as a function of stimulus intensity, which lasted for at least 20 minutes.

CONCLUSIONS

GCS has no effect on the peripheral nervous system. The GCS intolerance and the discomfort sometimes reported by patients do not derive from a dysfunction of the lower limb peripheral nervous system. A positive action on spinal reflex excitability is detected after walking while wearing GCS. We suggest that nervous descending activity due to voluntary contractions, and afferent cutaneous discharge, enhanced by movement under compression, converge on inhibitory interneurons, thus impinging on presynaptic pathways. All this can lead to an enhancement of the monosynaptic responses. Higher limb oxygenation detected during walking with GCS, found by other Authors, could increase the sensitivity of the muscle spindle afferents and/or motor neuron excitability resulting in an increase in H-reflex excitability, with potential positive effects on neuromuscular activities improving proprioception and postural control of the lower limbs.

摘要

背景

一项前瞻性研究,旨在调查脚踝处压力为23 - 32 mmHg的弹性长袜(梯度压力袜,GCS)对比目鱼肌在静息状态和步行训练后霍夫曼反射(H反射)的影响。

方法

14名受试者在不同时间穿着两种类型的GCS。在不穿GCS和穿着GCS静息时、穿着GCS步行后立即以及脱掉GCS 20分钟后进行电生理检查。

结果

使用GCS后周围神经传导保持不变。相反,穿着GCS步行会导致脊髓通路发生变化,表现为H阈值降低和H波幅随刺激强度增加,这种变化至少持续20分钟。

结论

GCS对周围神经系统没有影响。患者有时报告的GCS不耐受和不适并非源于下肢周围神经系统功能障碍。在穿着GCS步行后检测到对脊髓反射兴奋性有积极作用。我们认为,由于自主收缩引起的神经下行活动以及在压迫下运动增强的传入皮肤放电,汇聚到抑制性中间神经元,从而影响突触前通路。所有这些都可能导致单突触反应增强。其他作者发现,在穿着GCS步行期间检测到的较高肢体氧合可能会增加肌梭传入纤维的敏感性和/或运动神经元兴奋性,从而导致H反射兴奋性增加,对神经肌肉活动可能产生积极影响,改善下肢的本体感觉和姿势控制。

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