Prévinaire J G, Soler J M, Hanson P
Centre Médical du Cap Peyrefite, Cerbère, France.
Paraplegia. 1993 Jan;31(1):13-21. doi: 10.1038/sc.1993.3.
In order to investigate autonomic mechanisms associated with bladder filling and bladder contraction, skin potentials from the hands and the feet of 32 spinal cord injured patients were recorded during cystometry. All had a complete clinical loss of motor and sensory function below the lesion, but in 3 patients, the autonomic lesion was electrophysiologically assessed as incomplete. In patients with a complete autonomic lesion, any rise in intravesical pressure associated with bladder hyperreflexia induced SP responses below the level of the lesion. SP responses were never obtained during bladder filling, as the intravesical pressure remained low. These results tend to confirm those of Guttmann and Whitteridge, but differ in so far as SP responses at the foot were a regular finding in all paraplegic and in most tetraplegic patients. Furthermore, bladder contraction failed to elicit SP responses below the level of the lesion in patients with an incomplete autonomic lesion. This study emphasises the importance of assessing the integrity of the autonomic nervous pathways when dealing with autonomic mechanisms in spinal cord injured patients. The possible relation between SP responses and bladder neck dysfunction is further discussed.
为了研究与膀胱充盈和膀胱收缩相关的自主神经机制，在膀胱测压期间记录了32例脊髓损伤患者手部和足部的皮肤电位。所有患者在损伤平面以下均出现运动和感觉功能的完全临床丧失，但有3例患者的自主神经损伤经电生理评估为不完全性。在完全性自主神经损伤的患者中，与膀胱反射亢进相关的膀胱内压升高会在损伤平面以下诱发皮肤电位（SP）反应。在膀胱充盈期间从未获得过SP反应，因为膀胱内压保持较低水平。这些结果倾向于证实古特曼和惠特里奇的研究结果，但不同之处在于，在所有截瘫患者和大多数四肢瘫患者中，足部的SP反应是一项常规发现。此外，在自主神经损伤不完全的患者中，膀胱收缩未能在损伤平面以下诱发SP反应。本研究强调了在处理脊髓损伤患者的自主神经机制时评估自主神经通路完整性的重要性。进一步讨论了SP反应与膀胱颈功能障碍之间的可能关系。
