急性颈髓损伤与窦性心动过缓

Bradycardia associated with acute cervical spinal cord injury

创伤导致的严重的颈髓损伤 (CSCI)会使脊交感神经下行通路中断和交感神经节前神经元发生短暂的萎缩 ,而迷走神经的传入和传出冲动不会受到任何影响 ,导致交感神经与副交感神经张力失衡 ,发生窦性心动过缓 ,被称之为压力反射迷走神经性心动过缓 (BVB) ,严重者可出现心脏停搏。窦性心动过缓一般是发生于颈髓损伤后的 1周以内 ,持续时间一般为 7～ 10天。使用 β 肾上腺能受体激动剂 (如沙丁胺醇 )激活心脏交感神经的活性 ,能获得良好的临床治疗效果。

After severe cervical spinal cord injury (CSCI)the descending spinal sympathetic pathway can be interrupted,and an initial,transient atrophy of sympathetic preganglionic neurons was found.Unopposed parasympathetic tone may lead to overt bradycardia,a baroreflex vagal bradycardia(BVB)because of an intact vagal afferent and efferent pathway is in the CSCI patients.In extreme cases,this imbalance may result in cardiac arrest.The persistent bradycardia is found within the first week of post-injury and underwent 7 to 10 days.Management of the bradycardia with β-adrenergic receptor agonist,such as salbutamol,to activate cardiac sympathetics may be more available.