Autonomic dysreflexia during urodynamics
Autonomic dysreflexia during urodynamics
复制标题
DOI：
10.1038/sj.sc.3100684
复制
发表时间：
1998-11-01
期刊：
影响因子：
2.2
通讯作者：
Vespasiani, G
中科院分区：
文献类型：
--
作者：
Giannantoni, A;Di Stasi, SM;Vespasiani, G
自主神经反射异常（Autonomic dysreflexia，AD）是一种急性综合征，其特征是在TG水平以上的脊髓损伤患者中发生不适当的和大量的自主神经反应。目的：评估膀胱测压期间AD的发生率以及与临床和尿动力学特征的关系。患者和方法：四十-对8例脊髓损伤患者进行神经、泌尿系统检查和尿动力学评价，同时记录血液血压、心率以及AD的症状和体征。患者被认为有AD，如果血压达到高于150/100 mmHg的值。结果：所有的患者表现出收缩压和舒张压的显着增加，虽然只有20个显示压力值高于150/100 mmHg（其中7个没有AD症状）。AD在颈部患者中更常见（P = 0.034），但与任何其他临床特征无关：性别比，年龄，疾病持续时间，病变的完整性，逼尿肌反射亢进/无反射和逼尿肌-括约肌协同失调的发生率，排尿方式，抗胆碱能药物的使用。结论：（1）在尿动力学检查中，病变水平高于TG的患者均有交感神经刺激的征象，但仅有部分患者出现危险血压值;（2）尿动力学指标与反射障碍危象的关系表明，逼尿肌无抑制性收缩和膀胱扩张均能诱发反射障碍危象;（3）用抗胆碱能药物治疗不足以防止从膀胱开始的自主反射异常，除非它导致逼尿肌无反射。这些患者在膀胱扩张后有发生自主神经反射障碍的风险。
Autonomic dysreflexia (AD) is an acute syndrome characterised by inappropriate and massive autonomic response that occurs in patients with spinal cord injury above the TG level.Aims: to evaluate the incidence of AD during cystometry and the relationships with clinical and urodynamic features.Patients and methods: Forty-eight spinal cord injury patients were studied by neurological and urological examination and urodynamic evaluation with concurrent recording of blood pressure, heart rate and symptoms and signs of AD. Patients were considered to have AD if blood pressure reached values higher than 150/100 mmHg.Results: All the patients showed a significant increase of both systolic and diastolic blood pressure, although only 20 showed pressure values higher than 150/100 mmHg (in seven of them without AD symptoms). AD was more frequent in cervical patients (P = 0.034), but did not correlate with any other clinical features: sex ratio, age, disease duration, completeness of lesion, incidence of detrusor hyperreflexia/areflexia and detrusor-sphincter dyssynergia, voiding modalities, usage of anticholinergic drugs. In three patients blood pressure increase began when uninhibited contraction started, in 11 it was coincident with unhibited contraction peak and in the other six it appeared at maximum bladder capacity.Conclusions: (1) during urodynamic evaluation all the patients with lesion level above TG showed signs of sympathetic stimulation, although only some showed dangerous blood pressure values: (2) the relationship between urodynamic data and dysreflexia crisis shows that both the presence of detrusor uninhibited contractions and bladder distension are able to stimulate the crisis; (3) treatment with anticholinergic drugs is not sufficient to prevent autonomic dysreflexia starting fi om the bladder, unless it induces detrusor areflexia. These patients are at risk of developing autonomic dysreflexia following bladder distension.