Assessment of autonomic dysreflexia in patients with spinal cord injury
Assessment of autonomic dysreflexia in patients with spinal cord injury
复制标题
DOI：
10.1136/jnnp.62.5.473
复制
发表时间：
1997-05-01
影响因子：
11
通讯作者：
Dietz, V
中科院分区：
文献类型：
--
作者：
Curt, A;Nitsche, B;Dietz, V
目的和方法：评估脊髓损伤患者对脊髓交感神经中枢的脊髓上控制的损害和自主神经反射异常的发生。自主神经反射障碍是由脊髓交感神经中枢与脊髓上控制断开引起的，其特征是由病变水平以下的非特异性刺激引起的阵发性高血压发作。因此，我们对脊髓损伤患者进行了临床和不同技术的检查，以评估自主神经反射异常的发生，并将交感神经系统的紊乱与自主神经反射异常的发作联系起来。（91%的完全患者，27%的不完全患者）在尿动力学检查期间出现自主神经反射异常的体征。只有62%的四肢瘫痪患者抱怨自主神经反射障碍的症状。在93%的病例中，手部的病理性交感神经皮肤反应（SSR）与自主神经反射障碍的体征有关。无论是在临床上还是在尿动力学检查中，手脚SSR电位保留的患者都没有表现出自主反射障碍的迹象。动态血压测量（ABPM）表明，昼夜血压节律（交感神经控制）的损失，但保留心率节律（副交感神经调节），只有在完全性四肢瘫痪的患者。病理性ABPM。记录被认为是在70%的自主神经反射障碍的症状的患者。结论尿动力学检查是更敏感的自主神经反射障碍的患者脊髓损伤的迹象，而SSR允许的程度的评估断开脊髓交感神经中枢从脊髓上的控制。使用ABPM记录，可以评估24小时内自主神经反射异常发作的发生率和治疗性治疗的有效性。
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.