School of Rehabilitation Medicine, Capital Medical University, No. 10, Jiao Men Bei Lu, Fengtai District, Beijing, 100068, China.
Rehabilitation Department, Ruijing Hospital, Shanghai Jiaotong University School of Medicine, No. 197 Ruijin Er Lu, Huangpu District, Shanghai, 200001, China.
Sci Rep. 2021 Aug 5;11(1):15892. doi: 10.1038/s41598-021-95158-5.
Neurogenic bowel dysfunction, including hyperreflexic and areflexic bowel, is a common complication in patients with spinal cord injury (SCI). We hypothesized that removing part of the colonic sympathetic innervation can alleviate the hyperreflexic bowel, and investigated the effect of sympathectomy on the hyperreflexic bowel of SCI rats. The peri-arterial sympathectomy of the inferior mesenteric artery (PSIMA) was performed in T8 SCI rats. The defecation habits of rats, the water content of fresh faeces, the intestinal transmission function, the defecation pressure of the distal colon, and the down-regulation of Alpha-2 adrenergic receptors in colon secondary to PSIMA were evaluated. The incidence of typical hyperreflexic bowel was 95% in SCI rats. Compared to SCI control rats, PSIMA increased the faecal water content of SCI rats by 5-13% (P < 0.05), the emptying rate of the faeces in colon within 24 h by 14-40% (P < 0.05), and the defecation pressure of colon by 10-11 mmHg (P < 0.05). These effects lasted for at least 12 weeks after PSIMA. Immunofluorescence label showed the secondary down-regulation of Alpha-2 adrenergic receptors after PSIMA occurred mainly in rats' distal colon. PSIMA mainly removes the sympathetic innervation of the distal colon, and can relieve the hyperreflexic bowel in rats with SCI. The possible mechanism is to reduce the inhibitory effect of sympathetic activity, and enhance the regulatory effect of parasympathetic activity on the colon. This procedure could potentially be used for hyperreflexic bowel in patients with SCI.
神经源性肠道功能障碍，包括反射亢进性和弛缓性肠道，是脊髓损伤（SCI）患者的常见并发症。我们假设去除部分结肠交感神经支配可以缓解反射亢进性肠道，并研究了交感神经切除术对 SCI 大鼠反射亢进性肠道的影响。在 T8 SCI 大鼠中进行肠系膜下动脉周围交感神经切除术（PSIMA）。评估大鼠的排便习惯、新鲜粪便的含水量、肠道传输功能、远端结肠的排便压力以及 PSIMA 后结肠中 Alpha-2 肾上腺素能受体的下调。SCI 大鼠中典型反射亢进性肠道的发生率为 95%。与 SCI 对照组大鼠相比，PSIMA 使 SCI 大鼠的粪便含水量增加了 5-13%（P<0.05），24 小时内结肠内粪便排空率增加了 14-40%（P<0.05），结肠的排便压力增加了 10-11mmHg（P<0.05）。这些作用至少在 PSIMA 后持续 12 周。免疫荧光标记显示 PSIMA 后 Alpha-2 肾上腺素能受体的次级下调主要发生在大鼠的远端结肠。PSIMA 主要去除远端结肠的交感神经支配，可以缓解 SCI 大鼠的反射亢进性肠道。可能的机制是降低交感神经活动的抑制作用，并增强副交感神经对结肠的调节作用。该程序可能可用于治疗 SCI 患者的反射亢进性肠道。
