急性缺血性脑卒中后自主神经功能障碍导致的多系统并发症的研究进展  

Research progress in systemic complications induced by autonomic dysfunction after acute ischemic stroke

作　　者：钟佳琪 曹雯霏 周慧中 杨嘉君[1] ZHONG Jiaqi;CAO Wenfei;ZHOU Huizhong;YANG Jiajun(Department of Neurology,Shanghai Sixth People′s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院神经内科,上海200233

出　　处：《上海交通大学学报（医学版）》2024年第7期928-934,共7页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市科学技术委员会西医药引导项目(19411971400)。

摘　　要：脑血管疾病严重危害人类健康。最新流行病学资料显示,脑卒中为全球成人死亡及致残的主要原因之一。急性缺血性卒中(acute ischemic stroke,AIS)是由大脑局部血液循环障碍引起,占脑卒中的80%以上,为最常见的卒中类型。由于AIS对大脑皮质的广泛损害或病变直接累及自主神经中枢及通路,导致交感神经系统与副交感神经系统的平衡被打破(表现出以交感神经系统激活为主)。因此,交感与副交感神经系统下游所支配的靶器官因其分泌的神经递质的影响,产生一系列的系统性并发症(如心脏并发症、卒中相关感染、胃肠道并发症、急性肾损伤、代谢改变以及性功能障碍等)。反之,那些系统性的病理改变可能影响AIS的进展,从而加剧脑损伤或直接导致患者死亡。针对自主神经系统失衡的治疗可以起到减少并发症、改善AIS预后的作用。该文综述了AIS后自主神经功能障碍的全身性效应和其机制,为AIS的治疗及其系统并发症的干预提供参考。Cerebrovascular diseases pose a serious threat to human health.According to the latest epidemiological data,stroke is one of the leading causes of death and disability among adults worldwide.Acute ischemic stroke(AIS),which is caused by local circulatory disorders in the brain,accounts for over 80%of all strokes and is the most common type of stroke.Due to extensive damage to the cerebral cortex or direct involvement of the autonomic nerve centers and pathways caused by AIS,the balance between the sympathetic and parasympathetic nervous systems is disturbed(with a predominance of sympathetic activation).Therefore,the organs targeted by the downstream pathways of the sympathetic and parasympathetic nervous systems are affected by the neurotransmitters they secrete,resulting in a range of systemic complications(such as cardiac complications,stroke-related infections,gastrointestinal complications,acute kidney injury,metabolic changes,and sexual dysfunction).These systemic pathological changes,in turn,affect the progression of AIS,thereby exacerbating brain damage or directly leading to patient death.Treatments targeting imbalances in the autonomic nervous system may play a role in reducing complications and improving the prognosis of AIS.This article reviews the systemic effects of autonomic dysfunction following AIS and its mechanisms,providing insights for the treatment of AIS and intervention of systemic complications.

关 键 词：急性缺血性脑卒中 自主神经系统 并发症 交感神经系统 副交感神经系统 

分 类 号：R743.3[医药卫生—神经病学与精神病学]