Bannister R, da Costa D F, Hendry W G, Jacobs J, Mathias C J
Brain. 1986 Apr;109 ( Pt 2):345-56. doi: 10.1093/brain/109.2.345.
The clinical features, investigation and management of a patient with a subacute autonomic neuropathy are described. A series of physiological and biochemical studies indicated severe but selective sympathetic cardiovascular dysfunction, associated with bradycardia. The bradycardia was enhanced by raising blood pressure but there was no other evidence either of cardiac vagal impairment or hyperreactivity. Oral atropine prevented the bradycardia but had to be withdrawn because of intolerable side effects. An atrial demand pacemaker was implanted to elevate basal heart rate and prevent bradycardia. The pacemaker alone did not improve postural hypotension but it enabled the blood pressure to be readily and safely controlled by a combination of drugs.
本文描述了一名亚急性自主神经病变患者的临床特征、检查及治疗情况。一系列生理和生化研究表明存在严重但具有选择性的交感神经心血管功能障碍，并伴有心动过缓。血压升高会加重心动过缓，但未发现其他心脏迷走神经受损或反应性亢进的证据。口服阿托品可预防心动过缓，但因无法耐受的副作用而不得不停药。植入了按需型心房起搏器以提高基础心率并预防心动过缓。单独使用起搏器并不能改善体位性低血压，但它使联合使用药物能够轻松、安全地控制血压。
