应用交感皮肤反应评价脊髓损伤患者下尿路传入神经通路的研究

Evaluation of the function of afferent neuronal pathways of the lower urinary tract in patients with spinal cord injury by using sympathetic skin response

目的应用交感皮肤反应(SSR)评价脊髓损伤(SCI)患者的下尿路(LUT)传入神经通道的功能状况。方法选择21例SCI患者作为SCI组,包括完全损伤8例,不完全损伤13例,另选8例健康成年人作为正常组,分别给予正中神经、会阴部电刺激以及膀胱充盈来诱发SSR,用表面电极同时记录右侧手掌和右侧足底的SSR。结果正常组电刺激正中神经和会阴部均能诱发SSR;受试者膀胱充盈的过程中出现主观尿意感觉时,可诱发SSR。13例不完全损伤患者均有膀胱尿意感,电刺激其正中神经均能记录清晰的手掌和足底SSR;其中3例会阴部感觉丧失患者电刺激会阴部未诱发出SSR,而在膀胱充盈过程中能诱发出SSR,余患者SSR无异常。8例躯体感觉完全损伤者膀胱感觉功能完全丧失,电刺激正中神经时,损伤位于T3以上节段患者的手掌和足底均不能诱发出SSR,损伤位于T4～9节段患者仅能诱发出手掌SSR,T10以下节段损伤患者均能记录到手掌和足底SSR;所有患者会阴部电刺激和膀胱充盈过程中均不能诱发出手掌和足底SSR。结论膀胱充盈诱发的SSR与SCI患者来自下尿路的主观感觉相一致,应用膀胱充盈诱发SSR可客观地反映SCI患者下尿路传入神经通路的完整性。下尿路的躯体神经传入通路与自主神经传入通路是不同的。

Objective To evaluate the function of afferent neuronal pathways (ANP) from the lower urinary tract (LUT) in patients with spinal cord injury (SCI) by use of sympathetic skin response (SSR). Methods Twenty-one patients with SCI (13 cases of incomplete injury, and 8 cases of complete injury) were recruited as a SIC group and 8 healthy volunteers as a control group. SSRs of all subjects were evoked by means of electrical stimulation (ES) of the median nerve and perineal region,as well as bladder filling (BF), while SSRs of the right palm and sole were recorded using surface electrodes. Results SSRs induced by ES of the median nerve and perineal region, and also by BF in the control group were recorded. SSRs of palms and soles could be recorded by using ES of the median nerve in patients with incomplete SCI, who had desire to void. However, SSRs could not be evoked in 3 of 13 patients with incomplete SCI but without sensation of perineal skin. In 8 patients with complete SCI but without sensation of trunk skin and bladder, SSRs of palms and soles could not be induced during ES of the median nerve if injuries were located over T_3, and SSRs of palms were recorded when the injuries were located between T_(4~9), while SSRs of palms and soles were evoked if injuries were located under T_(10). However, SSRs of palms and soles could not be evoked by ES of perineal region and BF in all patients. Conclusion SSRs, evoked by BF, could concord with the subjective sensation of the subjects from the LUT, and reflect the integrity of ANP from LUT. There is difference between somatosensory and viscerosensory ANP.