自主神经过反射时血管活性物质的改变  

The changes of vasoactive substances duing autonomic hyperreflexia

作　　者：周国昌[1] 田汨[1] 唐和虎[1] 石晶[1] 周天健[1] 

机构地区：[1]中国康复研究中心脊柱脊髓外科,中国康复研究中心脊柱脊髓内科

出　　处：《中国脊柱脊髓杂志》1995年第6期244-247,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：以膀胱叩击诱发自主神经过反射（ＡＨＲ）法对１５例胸腰段脊髓损伤截瘫病人、１５例颈髓损伤四肢瘫病人进行检查。膀胱叩击前和叩击后分别测定血液中主要引起血压升高的血管活性物质去甲肾上腺素（ＮＥ）、肾上腺素（Ｅ）、肾素（Ｒ）和血管紧张素Ⅱ（ＡⅡ）。结果表明，叩击膀胱可引起四肢瘫病人发生ＡＨＲ，同时血中ＮＥ和Ｒ明显升高。通过膀胱叩击时四肢瘫和截瘫病人血管活性物质的变化，可认为：（１）由于ＮＥ为交感神经末梢传导神经冲动的主要神经介质，ＡＨＲ时血浆ＮＥ浓度增高，表明ＡＨＲ是由于交感神经兴奋所致。（２）ＡＨＲ时，由于仅血清Ｒ增高而血浆Ｅ和血清ＡⅡ无明显改变，故其血压变化与肾上腺的功能变化和肾素－血管紧张素系统的改变无关。The bladder of 30 patients with complete spinal cord injury was knocked at to elicit autonomic hyperreflexia (AHR). Half of them were with paraplegia. Before and during the perccusion of bladder,the concentration of vasoactive substances was measured: norepinephrine (NE ) and epinephrine (E)in plasma, and concentration of renine (R) as well as angiotensin Ⅱ (A Ⅱ) in serum. The results showed that: (1)Bladder perccusion can resulted in AHR in quadriplegia group; (2)Bladder perccusion caused increase of concentration of blood NE in these two groups. But the concentration of blood NE in quadriplegia group is much higher than in paraplegia group; (3)The increase of concentration of R in serum was only observed in group of quadriplegia during AHR; (4)No evident change of blood E and A Ⅱwas found during bladder perccusion. Increase of blood NE in patients with cervical spinal cord injury demonstrated that AHR actually is caused by the hyperreflexia of sympathetics below the level of spinal cord injury. Renine must convert angiotensinogen to angiotensin Ⅰ,then A Ⅰ will be converted to A Ⅱby converting enzyma. That the concertration of A Ⅱ and E had no changes during AHR means that there is no any relationship between AHR and renine angiotensin system as well as the adrenal gland.Author′ s address(Department of Spine and Spinal Cord, China Rehab. Research Center, Beijing,100077.)

关 键 词：脊髓损伤 自主神经过反射 血管活性物质 

分 类 号：R651.202[医药卫生—外科学]