Jänig W
Eur J Anaesthesiol. 1985 Dec;2(4):319-46.
The sympathetic nervous system is hierarchically organized. At the bottom of this organization are the sympathetic pre-post-ganglionic channels which supply the autonomic target organs, at the top the hypothalamus and cortical structures. Each level of this hierarchy contains neuronal programmes which govern the sympathetic activity in a patterned fashion. According to this hierarchy the reactions to noxious, tissue-damaging events, which are organized by the hypothalamus and suprahypothalamic brain structures, are of a more general character than those organized by the spinal cord, these being of a more specific character. The spinal cord is probably much more important than hitherto believed for integration and in determining the characteristic discharge patterns of the sympathetic pre- and post-ganglionic neurones. The defence reaction is described as a general reaction to noxious stimuli. Its sympathetic components consist of the patterns of discharge in sympathetic neurones supplying skin, skeletal muscle, viscera and adrenal medulla. It is organized in the hypothalamus and upper brain stem. The spinal cord integrates more specific somato-sympathetic, viscero-sympathetic and viscero-visceral reactions to noxious stimuli which are of a protective character. Visceral thoraco-lumbar afferents in 'sympathetic' nerves innervate visceral organs in the pelvic abdominal and thoracic cavities. Some innervate deep somatic structures of the ventral compartment of the vertebral column. No conclusive experimental evidence exists to show that they innervate skin and deep tissues of the extremities. Noxious events in the visceral domain are encoded by these visceral afferents. However, no convincing experimental evidence exists to show that this occurs by 'specific' visceral nociceptive afferents. It may well be that visceral noxious events are encoded by the intensity of the discharges in these neurones. No conclusive experimental evidence exists to show that peripheral nociceptors are controlled by activity in sympathetic post-ganglionic neurones. In certain pathophysiological situations, however, it may happen that activity in sympathetic post-ganglionic neurones, which supply an extremity, leads to excitation of afferent axons, thus establishing a vicious circle between primary afferent neurones, spinal cord and sympathetic outflow. This situation may occur after partial lesions of peripheral nerves in a syndrome which is called 'reflex sympathetic dystrophy'.
交感神经系统呈层级式组织。该组织的底层是供应自主目标器官的交感神经节前 - 节后通道，顶层是下丘脑和皮质结构。这个层级结构的每一层都包含以特定模式控制交感神经活动的神经元程序。根据这个层级结构，由下丘脑和下丘脑以上脑结构组织的对有害的、组织损伤性事件的反应，比由脊髓组织的反应具有更普遍的特征，而脊髓组织的反应具有更特定的特征。脊髓对于整合以及确定交感神经节前和节后神经元的特征性放电模式可能比迄今认为的更为重要。防御反应被描述为对有害刺激的一种普遍反应。其交感神经成分包括供应皮肤、骨骼肌、内脏和肾上腺髓质的交感神经元的放电模式。它在下丘脑和上脑干中组织形成。脊髓整合对有害刺激的更特定的躯体 - 交感、内脏 - 交感和内脏 - 内脏反应，这些反应具有保护性质。“交感”神经中的内脏胸腰段传入神经支配盆腔、腹腔和胸腔中的内脏器官。一些支配脊柱腹侧腔室的深部躯体结构。没有确凿的实验证据表明它们支配四肢的皮肤和深部组织。内脏区域的有害事件由这些内脏传入神经编码。然而，没有令人信服的实验证据表明这是通过“特定的”内脏伤害性传入神经发生的。很可能内脏有害事件是由这些神经元放电的强度编码的。没有确凿的实验证据表明外周伤害感受器受交感神经节后神经元活动的控制。然而，在某些病理生理情况下，供应四肢 的交感神经节后神经元的活动可能会导致传入轴突兴奋，从而在初级传入神经元、脊髓和交感神经输出之间形成恶性循环。这种情况可能发生在一种称为“反射性交感神经营养不良”的综合征的外周神经部分损伤之后。
