Mizushima T, Tajima F, Nakamura T, Yamamoto M, Lee K H, Ogata H
Department of Rehabilitation Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
Stroke. 1998 Mar;29(3):607-12. doi: 10.1161/01.str.29.3.607.
Autonomic dysfunction is frequently present in patients with cerebrovascular accidents (CVA). However, the pathophysiological mechanisms of these disorders are not clear. The purpose of the study was to assess the effects of CVA on the autonomic nervous system.
In eight male patients with a history of CVA with damage of the cortical or subcortical structures, we measured the cold pressor response during recording of muscle sympathetic nerve activity (MSNA) from the peroneal nerve on the hemiplegic side. We also studied 10 age-matched male control subjects. Tests were performed before, during, and after immersion of the nonhemiplegic hand in ice water for a period of 3 minutes in each phase. We also recorded changes in heart rate (HR), arterial blood pressure, skin temperature of the middle finger, and perception of pain using the Borg's score.
During the control period, the mean burst count of MSNA in CVA (57.2 +/- 3.9 beats/100 HR) was higher than in control subjects (36.3 +/- 3.2 beats/100 HR) (P<.05). Total MSNA (the mean burst amplitude per minute times burst rate) increased significantly in CVA and control during the immersion period by 79.9 +/- 18.4% and 133.1 +/- 25.6%, respectively. The percent change in total MSNA in CVA was attenuated during immersion compared with control subjects. The HR and skin temperature responses as well as the Borg's score were similar in both groups during control, hand immersion, and recovery periods.
The present results suggest that increased MSNA in CVA may be due to damage of cortical or subcortical structures or stroke-related changes in other areas or nonspecific changes that cause continuous increase in basal MSNA.
自主神经功能障碍在脑血管意外（CVA）患者中很常见。然而，这些疾病的病理生理机制尚不清楚。本研究的目的是评估CVA对自主神经系统的影响。
在8例有CVA病史且皮质或皮质下结构受损的男性患者中，我们在记录偏瘫侧腓总神经的肌肉交感神经活动（MSNA）时测量了冷加压反应。我们还研究了10名年龄匹配的男性对照受试者。在每个阶段，将非偏瘫手浸入冰水中3分钟，在浸入前、浸入期间和浸入后进行测试。我们还记录了心率（HR）、动脉血压、中指皮肤温度的变化以及使用博格评分法评估的疼痛感知。
在对照期，CVA患者的MSNA平均爆发计数（57.2±3.9次搏动/100次心率）高于对照受试者（36.3±3.2次搏动/100次心率）（P<0.05）。在浸入期，CVA组和对照组的总MSNA（每分钟平均爆发幅度乘以爆发率）分别显著增加了79.9±18.4%和133.1±25.6%。与对照受试者相比，CVA组在浸入期总MSNA的变化百分比有所减弱。在对照期、手浸入期和恢复期，两组的心率和皮肤温度反应以及博格评分相似。
目前的结果表明，CVA患者MSNA增加可能是由于皮质或皮质下结构受损、其他区域与中风相关的变化或导致基础MSNA持续增加的非特异性变化。
