Kewalramani L S
J Trauma. 1979 Apr;19(4):259-65. doi: 10.1097/00005373-197904000-00008.
Twenty-four of 576 consecutive patients with spinal cord injuries developed acute gastroduodenal ulceration and hemorrhage. Twenty-two were males and two were females: 88% were 12 to 25 years old. Seventeen patients sustained injuries to the spinal cord in sports and recreation related activities. Twenty-three patients had lesions of the spinal cord above the sympathetic outflow. Twenty patients developed gastroduodenal perforation or bleeding within 4 weeks following the injury. Ten patients developed perforation of gastric or duodenal ulcer and "shoulder tip" pain was a symptom of perforation in six patients. Six patients of seven who had gastroscopy and upper GI series were found at laparotomy to have ulcers. Gastric (nine) and duodenal (seven) ulcers were evenly distributed. There were no deaths due to gastroduodenal hemorrhage in the present series. A single cause for the pathogenesis of gastroduodenal ulceration and hemorrhage cannot be pinpointed. However, ischemia of gastric mucosa produced in various ways and altered equilibrium between the parasympathetic and sympathetic neural pathways following trauma to the spinal cord seem to be important in initiating the process.
在576例连续性脊髓损伤患者中，有24例发生了急性胃十二指肠溃疡和出血。其中22例为男性，2例为女性：88%的患者年龄在12至25岁之间。17例患者在与运动和娱乐相关的活动中发生脊髓损伤。23例患者的脊髓损伤位于交感神经传出纤维之上。20例患者在受伤后4周内发生胃十二指肠穿孔或出血。10例患者发生胃或十二指肠溃疡穿孔，6例患者出现“肩尖”疼痛作为穿孔的症状。7例行胃镜检查和上消化道造影的患者中，6例在剖腹手术时发现有溃疡。胃溃疡（9例）和十二指肠溃疡（7例）分布均匀。本系列中无因胃十二指肠出血导致的死亡病例。胃十二指肠溃疡和出血的发病机制不能确定单一病因。然而，以各种方式产生的胃黏膜缺血以及脊髓损伤后副交感神经和交感神经通路之间平衡的改变，在启动这一过程中似乎很重要。
