Barton C H, Khonsari F, Vaziri N D, Byrne C, Gordon S, Friis R
J Urol. 1986 Jan;135(1):83-5. doi: 10.1016/s0022-5347(17)45524-8.
Autonomic dysreflexia continues to be a major problem in spinal cord injury patients. In our report 16 patients with spinal cord lesions above the T6 level and a history of autonomic dysreflexia also had detrusor-sphincter dyssynergia. Of these patients 12 (75 per cent) had evidence of dysreflexia during cystometry. In addition, the dysreflexic response in blood pressure was shown to correlate with the high intravesical and urethral pressures measured during cystometry. Modified transurethral sphincterotomies subsequently were performed on all patients as recommended therapy for detrusor-sphincter dyssynergia. Repeat cystometry revealed significant decreases in intravesical and urethral pressures compared to before sphincterotomy (p less than 0.001) along with an associated significant decrease in blood pressure (p less than 0.01). Other dysreflexic responses also were markedly attenuated. These results suggest an association among detrusor-sphincter dyssynergia, high intravesical and urethral pressures, and autonomic dysreflexia. Our data indicate further that the frequency and magnitude of autonomic dysreflexia can be diminished significantly by modified external sphincterotomy.
自主神经反射异常仍然是脊髓损伤患者的一个主要问题。在我们的报告中，16例胸6以上脊髓损伤且有自主神经反射异常病史的患者也存在逼尿肌-括约肌协同失调。在这些患者中，12例（75%）在膀胱测压时有反射异常的证据。此外，血压的反射异常反应与膀胱测压期间测得的膀胱内高压和尿道高压相关。随后，按照推荐的治疗方法，对所有患者进行了改良经尿道括约肌切开术，以治疗逼尿肌-括约肌协同失调。重复膀胱测压显示，与括约肌切开术前相比，膀胱内压和尿道压显著降低（p<0.001），同时血压也显著下降（p<0.01）。其他反射异常反应也明显减弱。这些结果提示逼尿肌-括约肌协同失调、膀胱内高压和尿道高压与自主神经反射异常之间存在关联。我们的数据进一步表明，改良外括约肌切开术可显著降低自主神经反射异常的频率和严重程度。
