Low P A
Department of Neurology, Mayo Clinic, Rochester, MN 55905.
J Clin Neurophysiol. 1993 Jan;10(1):14-27. doi: 10.1097/00004691-199301000-00003.
Tests of autonomic function for the clinical autonomic neurophysiology laboratory should be noninvasive, sensitive, specific, reproducible, physiologically and clinically relevant, and not be excessively time-consuming. Laboratory evaluation is strongly indicated when the following are suspected: (1) generalized autonomic failure, (2) benign autonomic disorders that mimic life-threatening disorders, (3) distal small-fiber neuropathy, (4) the autonomic neuropathies, (5) sympathetically maintained pain, and (6) the postural orthostatic tachycardia syndrome. The preparation of the subject is important. Recommended tests should evaluate an adequate number of relevant autonomic systems. The Mayo laboratory utilizes two test batteries, the autonomic reflex screen and the reflex sympathetic dystrophy (RSD) screen. The former comprises the quantitative sudomotor axon reflex test (QSART), orthostatic blood pressure (BP) and heart rate (HR) responses to tilt, HR response to deep breathing, the Valsalva ratio, and beat-to-beat BP responses to the Valsalva maneuver, tilt, and deep breathing. The RSD screen comprises the recording of skin temperature, resting sweat output, and QSART distributions bilaterally.
临床自主神经生理学实验室的自主神经功能测试应具备无创性、敏感性、特异性、可重复性、生理和临床相关性，且不应耗时过长。当怀疑以下情况时，强烈建议进行实验室评估：（1）广泛性自主神经功能衰竭；（2）模仿危及生命疾病的良性自主神经疾病；（3）远端小纤维神经病变；（4）自主神经病变；（5）交感神经维持性疼痛；（6）体位性直立性心动过速综合征。受试者的准备工作很重要。推荐的测试应评估足够数量的相关自主神经系统。梅奥实验室采用两种测试组合，即自主神经反射筛查和反射性交感神经营养不良（RSD）筛查。前者包括定量汗腺轴突反射试验（QSART）、倾斜试验时的直立位血压（BP）和心率（HR）反应、深呼吸时的HR反应、瓦尔萨尔瓦比值以及瓦尔萨尔瓦动作、倾斜试验和深呼吸时的逐搏BP反应。RSD筛查包括双侧皮肤温度、静息出汗量和QSART分布的记录。
