脊髓损伤交感神经皮肤反应的应用研究
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摘要
目的:
研究旨在观察不同损伤程度与平面对脊髓损伤(SCI)患者交感神经皮肤反应(SSR)的影响,探索SCI后自主神经功能评估的客观方法及SSR对SCI损害程度评定的意义。对象和方法:
对象自2009-03～2010-03住院患者中选出完全性SCI组:10例(男/女:7/3),年龄38.8±12(22~59)岁,平均身高1.63±0.06m(1.55~1.75m),损伤平面T6以上3例,T8~T11为7例,损伤程度分级(AIS)为A,平均病程6.(22.5~18)月。不完全性SCI组:10例(男/女:9/1),年龄36.3±13(15~59)岁,平均身高1.67±0.06m(1.55~1.78m),损伤平面T6以上5例,T6~L3为5例,损伤程度分级(AIS)为B-2例,C-5例,D-3例,平均病程11.1(2~48)月。对照组(H):正常青年大学生中随机选出对照组正常健康受试者20例(男/女,11/9;年龄25±4岁)。
方法受试者仰卧,清醒,采用表面电极以50mA强度、波宽0.2ms的方波刺激左眶上神经、左正中神经、左胫神经,表面电极于双手掌心和双足心记录SSR,记录并分析SSR引出率、潜伏期和波幅。
结果:
完全性SCI患者3处刺激四肢记录SSR引出率均降低(与正常组比较p<0.05)。T6以上完全性损伤的患者,3处刺激均不能引出四肢的SSR,T6-T11患者能引出SSR者其波形和潜伏期与正常对照组均无显著差异(p>0.05)。不完全性SCI患者左胫神经刺激双足心记录时SSR引出率降低(p<0.05)。不完全性SCI的患者可引出SSR者,左正中神经刺激左掌心记录与正常对照组之间有显著差异(p<0.05)。双掌心记录到异常SSR的SCI患者中有50%的有过自主神经反射障碍(AD)发作史。
结论:
SCI患者中的SSR异常、且比正常人减弱或不能引出。SSR可作为评估不同平面与损害程度SCI患者的自主神经功能方法之一,尤其是交感神经的脊髓中枢完整性评估。双手心记录的SSR异常SCI患者,与其是否发生过AD可能有一定的关系。
Objectives:
The aim of this study is to find out the different features of sympathetic skin response(SSR) between the patients with spinal cord injury(SCI) and normal subjects. The SSR may be a new objective method to assess the integrity of spinal autonomic nervers (especially for sympathetic system) in the patients with SCI.
Subjects and methods:
Subjects Twenty chronic patients with SCI in different levels (neural level: range C5 to L3) and degrees (AIS: range A to D) were involved in the SSR testing. They were 16 male and only 4 female whose average age is 37±14(15~59) years. The duration for SCI onset was 2 weeks to 9 months. Meanwhile, 20 normal subjects(11 male and 9 female) were tested as the control group.
methods All subjects lie supine on the bed with the electrical stimulation in left supra orbital, median and tibial nerve respectively. At the same time, the record electrodes were set at the bilateral palms of two hands and soles of feet. The the shape, amplitude and lantency of SSR were analyzed in each group.
Results:
No matter where the electrode on , the detection rate of SSR in patient with complete spinal cord injury decreased(p<0.05). SSR could not be recorded in the patients with complete SCI above level T6 by stimulating left supra orbital, median and tibial nerve, respectively. There was no significant difference between control group and complete spinal cord injury group with T6 to T11(p>0.05). The rates of response at sole-SSR decreased when stimulated left tibial nerve in the patients with incomplete SCI(p<0.05). There was a significant difference between control group and incomplete spinal cord injury group when considering about initial latency and amplitude by stimulating left median never(p<0.05). Otherwise, nearly 50 percent of the patients with abnormal palm SSRs had one autonomic dysreflexia episode history.
Conclusion:
SSR of the patients with chronic SCI were abnormal and even disapeared by comparing with control group. We may apply the SSR to assess the impact of the autonomic nerve system, particularly for the sympathetic systems after spinal cord injury.
研究旨在观察不同损伤程度与平面对脊髓损伤(SCI)患者交感神经皮肤反应(SSR)的影响,探索SCI后自主神经功能评估的客观方法及SSR对SCI损害程度评定的意义。对象和方法:
对象自2009-03～2010-03住院患者中选出完全性SCI组:10例(男/女:7/3),年龄38.8±12(22~59)岁,平均身高1.63±0.06m(1.55~1.75m),损伤平面T6以上3例,T8~T11为7例,损伤程度分级(AIS)为A,平均病程6.(22.5~18)月。不完全性SCI组:10例(男/女:9/1),年龄36.3±13(15~59)岁,平均身高1.67±0.06m(1.55~1.78m),损伤平面T6以上5例,T6~L3为5例,损伤程度分级(AIS)为B-2例,C-5例,D-3例,平均病程11.1(2~48)月。对照组(H):正常青年大学生中随机选出对照组正常健康受试者20例(男/女,11/9;年龄25±4岁)。
方法受试者仰卧,清醒,采用表面电极以50mA强度、波宽0.2ms的方波刺激左眶上神经、左正中神经、左胫神经,表面电极于双手掌心和双足心记录SSR,记录并分析SSR引出率、潜伏期和波幅。
结果:
完全性SCI患者3处刺激四肢记录SSR引出率均降低(与正常组比较p<0.05)。T6以上完全性损伤的患者,3处刺激均不能引出四肢的SSR,T6-T11患者能引出SSR者其波形和潜伏期与正常对照组均无显著差异(p>0.05)。不完全性SCI患者左胫神经刺激双足心记录时SSR引出率降低(p<0.05)。不完全性SCI的患者可引出SSR者,左正中神经刺激左掌心记录与正常对照组之间有显著差异(p<0.05)。双掌心记录到异常SSR的SCI患者中有50%的有过自主神经反射障碍(AD)发作史。
结论:
SCI患者中的SSR异常、且比正常人减弱或不能引出。SSR可作为评估不同平面与损害程度SCI患者的自主神经功能方法之一,尤其是交感神经的脊髓中枢完整性评估。双手心记录的SSR异常SCI患者,与其是否发生过AD可能有一定的关系。
Objectives:
The aim of this study is to find out the different features of sympathetic skin response(SSR) between the patients with spinal cord injury(SCI) and normal subjects. The SSR may be a new objective method to assess the integrity of spinal autonomic nervers (especially for sympathetic system) in the patients with SCI.
Subjects and methods:
Subjects Twenty chronic patients with SCI in different levels (neural level: range C5 to L3) and degrees (AIS: range A to D) were involved in the SSR testing. They were 16 male and only 4 female whose average age is 37±14(15~59) years. The duration for SCI onset was 2 weeks to 9 months. Meanwhile, 20 normal subjects(11 male and 9 female) were tested as the control group.
methods All subjects lie supine on the bed with the electrical stimulation in left supra orbital, median and tibial nerve respectively. At the same time, the record electrodes were set at the bilateral palms of two hands and soles of feet. The the shape, amplitude and lantency of SSR were analyzed in each group.
Results:
No matter where the electrode on , the detection rate of SSR in patient with complete spinal cord injury decreased(p<0.05). SSR could not be recorded in the patients with complete SCI above level T6 by stimulating left supra orbital, median and tibial nerve, respectively. There was no significant difference between control group and complete spinal cord injury group with T6 to T11(p>0.05). The rates of response at sole-SSR decreased when stimulated left tibial nerve in the patients with incomplete SCI(p<0.05). There was a significant difference between control group and incomplete spinal cord injury group when considering about initial latency and amplitude by stimulating left median never(p<0.05). Otherwise, nearly 50 percent of the patients with abnormal palm SSRs had one autonomic dysreflexia episode history.
Conclusion:
SSR of the patients with chronic SCI were abnormal and even disapeared by comparing with control group. We may apply the SSR to assess the impact of the autonomic nerve system, particularly for the sympathetic systems after spinal cord injury.
引文
[1] Marino RJ, Barros T, Biering-Sorensen F, etal. International standards for neurological Classification of spinal cord injury[J].J Spinal Cord Med 2003, 26:S50–S56
[2] Kerr FW, Alexander S. Descending autonomic pathways in the spinal cord[J]. Arch Neurol 1964,10:249-261
[3] Takahashi M, Matsukawa K, Nakamoto T, Tsuchimochi H, Sakaguchi A, Kawaguchi K, Onari K. Control of heart rate variability by cardiac parasympathetic nerve activity during voluntary static exercise in humans with tetraplegia[J].J Appl Physiol,2007,103(5):1669-1677.
[4] Krassioukov AV, Karlsson AK, Wecht JM, Wuermser LA, Mathias CJ, Marino RJ. Assessment of autonomic dysfunction following spinal cord injury: rationale for additions to International Standards for Neurological Assessment[J].J Rehabil Res Dev,2007,44(1):103-112
[5] Schondorf R. New investigations of autonomic nervous system function[J].J Clin Neurophysiol,1993,10(1):28–38
[6] Yokkota T, Matsunaga T, Okiyama R, Hirose K, Tanabe H, Furukawa T, Tsukagoshi H. Sympathetic skin response in patients with multiple sclerosis compared with patients with spinal cord transection and normal controls[J].Brain,1991,114(3):1381-1394
[7] Curt A, Weinhardt C, Dietz V. Significance of sympathetic skin response in the assessment of autonomic failure in patients with spinal cord injury[J].J Auton Nerv Syst,1996,61(2):175-180
[8] Nair KPS, Taly AB, Arunodaya GR, Rao S, Murali T. Sympathetic skin response in myelopathies[J].Clin Auton Res,1998,8(4):207-211
[9] Maynard FM Jr, Bracken MB, Creasey G et al. International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association[J].Spinal Cord,1997,35(5):266-274
[10]Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response: basic mechanisms and clinical applications[J].Clin Auton Res,2003,13(4):256-270.
[11] Drory VE, Korczyn AD. Sympathetic skin response:age effect[J].Neurology 1993,43:1818-1820
[12] Deltombe T, Hanson P, Jamart J, Clerin M. The influence of skin temperature on latency and amplitude of the sympathetic skin response in normal subjects[J].Muscle Nerve,1998,21(1):34-39
[13] Levy DM, Reid G., Rowley DA. Abraham, RR. Quantitative measures of sympathetic skin response in diabetes: relation to sudomotor and neurological function. J Neurol Neurosurg Psychiat,1992,55:902-908
[14] Knezevic W, Bajada S. Peripheral autonomic surface potential.A quantitative technique for recording sympathetic conduction in man[J].J Neurol Sci 1985, 67:239-251
[15] Bannister R, eds. Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System. 4th ed. Oxford, UK: Oxford University Press,2002:494-513
[16] Chroni E, Argyriou AA, Polychronopoulos P et al. The effect of stimulation technique on sympathetic skin responses in healthy subjects[J].Clin Auton Res, 2006,16(6):396-400
[17] Arunodaya GR, Taly AB. Sympathetic skin response:a decade later[J].J Neurol Sci,1995,129:81-89
[18] Cariga P, Catley M, Mathias CJ, Ellaway PH. Characteristics of habituation of the sympathetic skin response to repeated Electrical stimuliinman[J].Clin Neurophy siol,2001,112:1875-1880
[19] Toyokura M. Paradoxical shortening of sympathetic skin response latency at distal recording sites[J].Clin Neurophysiol,2009,120(1):123-127
[20] Cariga P, Catley M,Mathias CJ, Savic G, rankel HL, Ellaway PH. Organisation of the sympathetic skin response in spinal cord injury[J].J Neurol Neurosurg Psychiatry,2002,72:356-360
[21] T Ogura, T Kubo, K Lee, Y Katayama, Y Kira, S Aramaki. Sympathetic skin response in patients with spinal cord injury[J].Journal of Orthopaedic Surgery, 2004,12:35-39
[22] Dolinak D, Balraj E. Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury[J].Am J Forensic Med Pathol,2007,28(2):95-98
[23] Elspeth M. McLachlan. Diversity of sympathetic vasoconstrictor pathways and their plasticity after spinal cord injury[J].Clin Auton Res,2007,17:6-12
[24] McLachlan EM, Brock JA. Adaptations of peripheral vasoconstrictor pathways after spinal cord injury[J].Prog Brain Res,2006,152:289-297.
[25]Teasell RW, Arnold JM, Krassioukov A et al. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury[J].Arch Phys Med Rehabil,2000,81(4):506-516
[26] Tolbert G, Tuck ML. Ambulatory blood pressure monitoring in persons with chronic spinal cord injury[J].J Spinal Cord Med,2004,27(5):476-480
[27] Shergill IS, Arya M, Hamid R et al. The importance of autonomic dysreflexia to the urologist[J].BJU Int,2004,93(7):923-926
[28] Kirshblum SC, House JG, O'connor KC. Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: a preliminary study[J].Arch Phys Med Rehabil,2002,83(12):1774-1776
[29] Giannantoni A, Di Stasi SM, Scivoletto G et al. Autonomic dysreflexia during urodynamics[J].Spinal Cord,1998,36(11):756-760
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[32] Curt A, Nitsche B, Rodic B, Dictz V. Assessment of autonomic dysreflexia in patients with spinal cord injury[J].J Neurol Neurosurg Psychiatry,1997, 62(5):473-477
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[2] Kerr FW, Alexander S. Descending autonomic pathways in the spinal cord[J]. Arch Neurol 1964,10:249-261
[3] Takahashi M, Matsukawa K, Nakamoto T, Tsuchimochi H, Sakaguchi A, Kawaguchi K, Onari K. Control of heart rate variability by cardiac parasympathetic nerve activity during voluntary static exercise in humans with tetraplegia[J].J Appl Physiol,2007,103(5):1669-1677.
[4] Krassioukov AV, Karlsson AK, Wecht JM, Wuermser LA, Mathias CJ, Marino RJ. Assessment of autonomic dysfunction following spinal cord injury: rationale for additions to International Standards for Neurological Assessment[J].J Rehabil Res Dev,2007,44(1):103-112
[5] Schondorf R. New investigations of autonomic nervous system function[J].J Clin Neurophysiol,1993,10(1):28–38
[6] Yokkota T, Matsunaga T, Okiyama R, Hirose K, Tanabe H, Furukawa T, Tsukagoshi H. Sympathetic skin response in patients with multiple sclerosis compared with patients with spinal cord transection and normal controls[J].Brain,1991,114(3):1381-1394
[7] Curt A, Weinhardt C, Dietz V. Significance of sympathetic skin response in the assessment of autonomic failure in patients with spinal cord injury[J].J Auton Nerv Syst,1996,61(2):175-180
[8] Nair KPS, Taly AB, Arunodaya GR, Rao S, Murali T. Sympathetic skin response in myelopathies[J].Clin Auton Res,1998,8(4):207-211
[9] Maynard FM Jr, Bracken MB, Creasey G et al. International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association[J].Spinal Cord,1997,35(5):266-274
[10]Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response: basic mechanisms and clinical applications[J].Clin Auton Res,2003,13(4):256-270.
[11] Drory VE, Korczyn AD. Sympathetic skin response:age effect[J].Neurology 1993,43:1818-1820
[12] Deltombe T, Hanson P, Jamart J, Clerin M. The influence of skin temperature on latency and amplitude of the sympathetic skin response in normal subjects[J].Muscle Nerve,1998,21(1):34-39
[13] Levy DM, Reid G., Rowley DA. Abraham, RR. Quantitative measures of sympathetic skin response in diabetes: relation to sudomotor and neurological function. J Neurol Neurosurg Psychiat,1992,55:902-908
[14] Knezevic W, Bajada S. Peripheral autonomic surface potential.A quantitative technique for recording sympathetic conduction in man[J].J Neurol Sci 1985, 67:239-251
[15] Bannister R, eds. Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System. 4th ed. Oxford, UK: Oxford University Press,2002:494-513
[16] Chroni E, Argyriou AA, Polychronopoulos P et al. The effect of stimulation technique on sympathetic skin responses in healthy subjects[J].Clin Auton Res, 2006,16(6):396-400
[17] Arunodaya GR, Taly AB. Sympathetic skin response:a decade later[J].J Neurol Sci,1995,129:81-89
[18] Cariga P, Catley M, Mathias CJ, Ellaway PH. Characteristics of habituation of the sympathetic skin response to repeated Electrical stimuliinman[J].Clin Neurophy siol,2001,112:1875-1880
[19] Toyokura M. Paradoxical shortening of sympathetic skin response latency at distal recording sites[J].Clin Neurophysiol,2009,120(1):123-127
[20] Cariga P, Catley M,Mathias CJ, Savic G, rankel HL, Ellaway PH. Organisation of the sympathetic skin response in spinal cord injury[J].J Neurol Neurosurg Psychiatry,2002,72:356-360
[21] T Ogura, T Kubo, K Lee, Y Katayama, Y Kira, S Aramaki. Sympathetic skin response in patients with spinal cord injury[J].Journal of Orthopaedic Surgery, 2004,12:35-39
[22] Dolinak D, Balraj E. Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury[J].Am J Forensic Med Pathol,2007,28(2):95-98
[23] Elspeth M. McLachlan. Diversity of sympathetic vasoconstrictor pathways and their plasticity after spinal cord injury[J].Clin Auton Res,2007,17:6-12
[24] McLachlan EM, Brock JA. Adaptations of peripheral vasoconstrictor pathways after spinal cord injury[J].Prog Brain Res,2006,152:289-297.
[25]Teasell RW, Arnold JM, Krassioukov A et al. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury[J].Arch Phys Med Rehabil,2000,81(4):506-516
[26] Tolbert G, Tuck ML. Ambulatory blood pressure monitoring in persons with chronic spinal cord injury[J].J Spinal Cord Med,2004,27(5):476-480
[27] Shergill IS, Arya M, Hamid R et al. The importance of autonomic dysreflexia to the urologist[J].BJU Int,2004,93(7):923-926
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