脊髓损伤患者自主神经功能障碍的临床研究

Clinical study of dysautonomia in spinal cord injury patients

目的:通过检测健康人群和不同节段脊髓损伤患者心率变异性(HRV),探讨脊髓损伤患者是否存在自主神经的功能障碍,以及不同节段脊髓损伤患者的自主神经的功能障碍程度是否相同。方法:依据脊髓损伤节段的不同将截瘫患者分为颈段及T1-5节段脊髓损伤组11例,T6-12脊髓损伤组7例,腰髓损伤6例;健康体检人群19例作为正常对照组。采用短程动态记录安静状态下心电图并进行HRV分析。结果:颈段及T1-5脊髓损伤组代表交感和迷走神经张力总合的低频检测结果301.41±358.60ms2较正常人群的620.19±333.36ms2明显降低(P<0.05),而且所有脊髓损伤组的低频/高频比值在C1-T5为1.66±1.00、T6-12为4.03±2.66、腰髓及以下为3.35±1.89,较正常人群的2.29±0.58明显异常(P<0.05),同时不同脊髓损伤组之间的检测结果不存在显著性差异(P>0.05)。结论:脊髓损伤患者存在自主神经的功能障碍,但不同节段脊髓损伤组之间的自主神经功能障碍不存在显著性差异。

Objective： To investigate the basis of obvious dysautonomia in spinal cord injury（SCI） patients compared with healthy people and to detect the different level of dysautonomia by measuring HRV. Method： The SCI patients were divided into cervical and thoracic cord 1-5 level group （C-T5, 11 patients）,under thoracic cord 6 level group （including lumbar cord, 13 patients）, There were 19 healthy people in health control group. HRV were measured by Holter analytical system in the morning at silence state. Result： The result of LF test that represented the total tone of sympathesis and vagal in C-T5 group decreased significantly than that in health group （P〈0.05）; All the LF/HF ratio in SCI patients changed obviously than that in health group （P〈0.05）; At the same time there was no obvious difference between two SCI groups about HRV （P〉0.05）. Conclusion： There are dysautonomia in spinal cord injury patients. There are no obvious difference about dysautonomia in different level SCI patients.