Almenoff P L, Alexander L R, Spungen A M, Lesser M D, Bauman W A
Department of Medicine, Mount Sinai School of Medicine, New York, USA.
Paraplegia. 1995 May;33(5):274-7. doi: 10.1038/sc.1995.62.
Airway hyperresponsiveness was recently described in patients with chronic cervical spinal cord injury (tetraplegia). The response was attributed to unopposed cholinergic broncho-constrictor activity due to loss of sympathetic innervation of the airway. To determine if the administration of a cholinergic antagonist alters resting airway tone in these patients, ipratropium bromide (72 micrograms) was administered by aerosol to 25 tetraplegic patients. We found that 12 of 25 patients (48%) had significant improvement (defined as > or = 12%) in forced expired volume in 1 s (FEV1) and/or forced vital capacity (FVC). A significant correlation between airway responsiveness and complaints of dyspnea at rest, completeness of injury (sensory), or smoking history was not found. These findings of improved airflow after the use of an anticholinergic bronchodilator agent provides further evidence that transection of the cervical cord results in unopposed parasympathetic activity and a resultant increase in resting airway tone.
最近在慢性颈脊髓损伤（四肢瘫痪）患者中发现了气道高反应性。这种反应归因于气道交感神经支配丧失导致胆碱能支气管收缩活动不受抑制。为了确定给予胆碱能拮抗剂是否会改变这些患者的静息气道张力，对25例四肢瘫痪患者雾化吸入异丙托溴铵（72微克）。我们发现，25例患者中有12例（48%）一秒用力呼气容积（FEV1）和/或用力肺活量（FVC）有显著改善（定义为≥12%）。未发现气道反应性与静息时呼吸困难主诉、损伤完整性（感觉）或吸烟史之间存在显著相关性。使用抗胆碱能支气管扩张剂后气流改善的这些发现进一步证明，颈髓横断会导致副交感神经活动不受抑制，并导致静息气道张力增加。
