Birklein Frank, Riedl Bernhard, Neundörfer Bernhard, Handwerker Hermann O
Neurologische Klinik, Friedrich-Alexander-Universität Erlangen, Erlangen, Germany Institut für Physiologie und experimentelle Pathophysiologie, Friedrich-Alexander-Universität Erlangen, Erlangen, Germany.
Pain. 1998 Mar;75(1):93-100. doi: 10.1016/S0304-3959(97)00209-1.
Twenty patients suffering from complex regional pain syndrome (CRPS) and 21 healthy control subjects were examined to evaluate sympathetic reflex vasoconstriction. The mean age of the 12 female and eight male patients was 48.9 (21-72) years. At the time of investigation the median duration of the disease was 8.5 weeks (2-70). Twenty-one healthy subjects were investigated for control. Different maneuvers, such as the veno-arteriolar reflex (VAR), inspiratory gasp (IG), cold pressor test (CP) and mental arithmetic (MA), were employed to induce vasoconstriction while the cutaneous blood flow of the affected and the contralateral limb was recorded. In addition, the skin temperature of both limbs was measured by infrared thermography. In 14 of 20 patients and in 14 of 21 control subjects vasoconstriction due to the provocation tests could be measured, while the remaining six patients and seven controls showed vasodilatation in at least one test, and by that they were excluded from analysis of vasoconstrictor reflex pattern. After thermoregulatory adaptation skin temperature was not different between the affected and the unaffected limb. Sympathetic reflex vasoconstriction triggered by MA which represents cortical generated, moderate vasoconstrictor stimulus, was significantly reduced on the affected limb (102.9% of prestimulus period) when compared to the control limb (85.0%, P < 0.002) or to controls (84.8%, P < 0.001). VAR (pure postganglionic), IG and CP (both spinal and supraspinal), representing stronger vasoconstrictor stimuli, revealed no significant side to side difference of sympathetic vasoconstriction and no significant difference as compared to controls. In conclusion our findings prove impairment of sympathetic vasoconstrictor activity after central vasoconstrictor stimulation in CRPS, and possible mechanisms are discussed.
对20名患有复杂性区域疼痛综合征（CRPS）的患者和21名健康对照者进行检查，以评估交感神经反射性血管收缩。12名女性和8名男性患者的平均年龄为48.9岁（21 - 72岁）。在调查时，疾病的中位持续时间为8.5周（2 - 70周）。对21名健康受试者进行调查作为对照。采用不同的手法，如静脉 - 小动脉反射（VAR）、吸气屏气（IG）、冷加压试验（CP）和心算（MA）来诱导血管收缩，同时记录患侧和对侧肢体的皮肤血流。此外，通过红外热成像测量双下肢的皮肤温度。20名患者中有14名以及21名对照者中有14名可测量到激发试验引起的血管收缩，而其余6名患者和7名对照者在至少一项试验中表现为血管舒张，因此他们被排除在血管收缩反射模式分析之外。在体温调节适应后，患侧和未患侧肢体的皮肤温度没有差异。与对照肢体（85.0%，P < 0.002）或对照组（84.8%，P < 0.001）相比，由心算引发的交感神经反射性血管收缩（代表皮质产生的中度血管收缩刺激）在患侧肢体上显著降低（刺激前时期的102.9%）。VAR（纯节后）、IG和CP（脊髓和脊髓上的）代表更强的血管收缩刺激，显示交感神经血管收缩在左右两侧没有显著差异，与对照组相比也没有显著差异。总之，我们的研究结果证明了CRPS患者在中枢性血管收缩刺激后交感神经血管收缩活动受损，并对可能的机制进行了讨论。
