自律神経過反射の臨床的検討

Abstract

25名の自律神経過反射を示す脊髄損傷者を対象として検討した.(1)脊髄損傷レベルでは第5胸髄以上が19名(76%), 第6胸髄以下が6名(24%)であった.症状の発現時期は受傷後1年以内が20名(80%)と最多であった.症状は発汗, 頭痛, 悪心などであった.(2)血圧を同時測定しつつ膀胱内圧を測定した.収縮期, 拡張期血圧ともに, 膀胱最高容量時では注水前より有意に上昇し, 排水後は最高容量時より有意に下降した.レギチン負荷後に同様の検査を施行したが, 血圧の上昇率はコントロール値の2/3に軽減した.(3)治療は間欠導尿や経尿道的括約筋切開術で排尿効率の改善をはかるとともに, α-交感神経遮断剤(POB)や交感神経節遮断剤(インスリン)を併用して, 22名(88%)で有効であった

Autonomic hyperreflexia in 25 patients with spinal cord injury has been clinically analyzed. Nineteen of the patients (76%) suffered from neurogenic lesions above Th-5 and the rest (24%) below Th-6. The most frequent subjective symptom was sweating (22 patients), followed by headache, nausea and so forth. These symptoms were encountered mostly in patients with poor voiding efficiency and developed less than one year after the spinal cord injury. Both systolic and diastolic blood pressure elevated with the distension of the bladder. At the maximum bladder capacity both systolic and diastolic pressure were 39% higher than that observed in the empty bladder. Regitin, 10 mg, given intravenously suppressed this elevation by two-thirds compared to the control. The treatment modality consisted of clean intermittent catheterization and external sphincterotomy, to prevent the over-stretching of the detrusor muscle, together with administration of alpha-adrenergic blockers and ganglionic blocking agent, which interrupt the efferent impulse. Twenty two of the patients (88%) were successfully controlled.