James J. Peters VA Medical Center, Bronx, New York, USA.
Bronx Veterans Medical Research Foundation, Bronx, New York, USA.
J Neurotrauma. 2022 Dec;39(23-24):1636-1644. doi: 10.1089/neu.2021.0379. Epub 2022 Jun 17.
Assessment of the degree of impaired autonomic nervous system (ANS) function is not part of routine clinical practice during inpatient rehabilitation following traumatic spinal cord injury (SCI). The goal of this investigation was to determine the utility of the International Standards for Neurologic Classification of SCI (ISNCSCI) and the recently revised International Standards to document remaining Autonomic Function after SCI (ISAFSCI) in documenting cardiovascular ANS impairment during inpatient rehabilitation following traumatic SCI. Beat-to-beat recording of supine heart rate (HR) and blood pressure (BP) were collected at the bedside for estimation of total cardiovascular ISAFSCI score, cardio-vagal modulation (i.e., high frequency HR variability [HF]) and sympathetic vasomotor regulation (i.e., Mayer wave component of systolic BP [SBP]). A total of 41 participants completed baseline testing, which was conducted 11 ± 5 days from the admission ISNCSCI examination. There were no differences in supine HR or BP based on the ISNCSCI or ISAFSCI assessments. The HF was generally lower with more distal lesions (r = 0.15; = 0.01), and SBP was significantly lower in those with American Spinal Injury Association Impairment Scale (AIS) A compared with AIS B, C, D (Cohen's d = -1.4; < 0.001). There were no significant differences in HF or SBP in patients with or without ISAFSCI evidence of cardiovascular ANS impairment. These preliminary data suggest that neither the ISNCSCI nor the ISAFSCI are sensitive to changes in ANS cardiovascular function following traumatic SCI. Bedside assessment of HR and BP variabilities may provide insight, but are not readily available in the clinical setting. Further research is required to evaluate methods that accurately assess the degree of ANS impairment following traumatic SCI.
评估自主神经系统(ANS)功能受损的程度并不是创伤性脊髓损伤(SCI)住院康复期间常规临床实践的一部分。本研究的目的是确定国际 SCI 神经分类标准(ISNCSCI)和最近修订的国际 SCI 后自主功能标准(ISAFSCI)在记录创伤性 SCI 后住院康复期间心血管 ANS 损伤方面的效用。在床边记录仰卧位心率(HR)和血压(BP),以估计总心血管 ISAFSCI 评分、心脏迷走神经调制(即高频 HR 变异性[HF])和交感血管运动调节(即收缩压[SBP]的 Mayer 波分量)。共有 41 名参与者完成了基线测试,该测试在入院 ISNCSCI 检查后 11 ± 5 天进行。根据 ISNCSCI 或 ISAFSCI 评估,仰卧位 HR 或 BP 没有差异。HF 通常随病变部位越远而降低(r=0.15;P=0.01),且美国脊髓损伤协会损伤量表(AIS)A 级患者的 SBP 明显低于 AIS B、C、D 级患者(Cohen's d=-1.4;P<0.001)。在有或没有心血管 ANS 损伤的 ISAFSCI 证据的患者中,HF 或 SBP 没有显著差异。这些初步数据表明,ISNCSCI 和 ISAFSCI 都不能敏感地反映创伤性 SCI 后 ANS 心血管功能的变化。HR 和 BP 变异性的床边评估可能提供深入了解,但在临床环境中不易获得。需要进一步研究来评估准确评估创伤性 SCI 后 ANS 损伤程度的方法。