脊髓损伤患者自主神经反射异常的评估
Assessment of autonomic dysreflexia in patients with spinal cord injury.
作者信息
Curt A, Nitsche B, Rodic B, Schurch B, Dietz V
机构信息
Swiss Paraplegic Centre, University Hospital Balgrist, Zurich.
出版信息
J Neurol Neurosurg Psychiatry. 1997 May;62(5):473-7. doi: 10.1136/jnnp.62.5.473.
OBJECTIVES AND METHODS
To assess the impairment of supraspinal control over spinal sympathetic centres and the occurrence of autonomic dysreflexia in patients with spinal cord injury. Autonomic dysreflexia is caused by the disconnection of spinal sympathetic centres from supraspinal control and is characterised by paroxysmal hypertensive episodes caused by non-specific stimuli below the level of the lesion. Therefore, patients with spinal cord injury were examined clinically and by different techniques to assess the occurrence of autonomic dysreflexia and to relate disturbances of the sympathetic nervous system to episodes of autonomic dysreflexia.
RESULTS
None of the paraplegic patients, but 59% (13/22) of tetraplegic patients (91% of the complete, 27% of the incomplete patients) presented signs of autonomic dysreflexia during urodynamic examination. Only 62% of the tetraplegic patients complained about symptoms of autonomic dysreflexia. Pathological sympathetic skin responses (SSRs) of the hands were related to signs of autonomic dysreflexia in 93% of cases. No patient with preserved SSR potentials of the hands and feet showed signs of autonomic dysreflexia, either clinically or during urodynamic examination. Ambulatory blood pressure measurements (ABPMs) indicated a loss of circadian blood pressure rhythm (sympathetic control) but preserved heart rate rhythm (parasympathetic regulation) only in patients with complete tetraplegia. Pathological ABPM recordings were seen in 70% of patients with symptoms of autonomic dysreflexia.
CONCLUSIONS
The urodynamic examination was more sensitive in indicating signs of autonomic dysreflexia in patients with spinal cord injury, whereas SSR allowed the assessment of the degree of disconnection of the sympathetic spinal centres from supraspinal control. Using ABPM recordings the occurrence of episodes of autonomic dysreflexia over 24 hours and the effectiveness of therapeutical treatment can be assessed.
目的与方法
评估脊髓损伤患者脊髓上中枢对脊髓交感神经中枢的控制受损情况以及自主神经反射异常的发生情况。自主神经反射异常是由脊髓交感神经中枢与脊髓上控制的分离引起的，其特征是损伤平面以下的非特异性刺激导致阵发性高血压发作。因此，对脊髓损伤患者进行了临床检查和不同技术检查，以评估自主神经反射异常的发生情况，并将交感神经系统的紊乱与自主神经反射异常发作相关联。
结果
截瘫患者中无人出现自主神经反射异常的体征，但在尿动力学检查期间，59%（13/22）的四肢瘫患者（91%的完全性患者，27%的不完全性患者）出现了自主神经反射异常的体征。只有62%的四肢瘫患者抱怨有自主神经反射异常的症状。手部病理性交感神经皮肤反应（SSR）在93%的病例中与自主神经反射异常的体征相关。手脚SSR电位未受损的患者在临床或尿动力学检查中均未出现自主神经反射异常的体征。动态血压测量（ABPM）表明，仅在完全性四肢瘫患者中出现昼夜血压节律（交感神经控制）丧失但心率节律（副交感神经调节）保留的情况。70%有自主神经反射异常症状的患者出现病理性ABPM记录。
结论
尿动力学检查在提示脊髓损伤患者自主神经反射异常体征方面更敏感，而SSR可用于评估脊髓交感神经中枢与脊髓上控制的分离程度。使用ABPM记录可评估24小时内自主神经反射异常发作的情况以及治疗效果。
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