dysfunction in SCI Spinal cord injuries help 植物神经功能紊乱在SCI脊髓损伤帮助ppt课件.ppt

Chronic Autonomic Dysfunction in SCI;Aims of this Session;SCI affects the somatic (i.e. the sensory and motor pathways we are aware of and can control) nervous system below the level of the injury However the autonomic (i.e. ‘self-regulating’) nervous system is also affected, and, like the somatic central nervous system, the severity and extent of the damage is largely related to the level and neurological completeness of the injury ;What is the Autonomic Nervous System?;Parasympathetic;Sympathetic;What is the Autonomic Nervous System?;As we have seen the parasympathetic and sympathetic tend to involve distinct levels of the spinal cord This means that the nature of the autonomic dysfunction in an individual is heavily influenced by the location and extent of the SCI ;Autonomic Dysfunction Landmarks;Neurological Completeness of Injury: Risk of Severe Autonomic Episodes;High Risk Group: AIS ‘A’ Tetraplegics;After spinal shock has subsided, there will be a persistent autonomic dyssynergy, again relative to level and density of lesion The parasympathetic and sympathetic systems will not be properly moderated or inhibited by each other, which will often result in hyperreflexia, particularly of the sympathetic system This will often have evident functional physiological consequences ;Cardiovascular System;Respiratory system;Gastrointestinal System;Skin;Genitourinary System;Chronic Autonomic Dysfunction in SCI;Distressing autonomic symptoms can often be addressed rationally. For example: Sweating often responds to sympatheticomimetics (oxybutynin etc) Postural hypotension is treated by gradual mobilisation, and use of elastic stockings and abdominal binder. Sometimes ephedrine is used However attention must be given to any underlying cause- particularly bladder and bowel management;What is Autonomic Dysreflexia?; The noxious stimulus triggers unmediated sympathetic reflex activity which causes massive vasoconstriction below the level of injury. This in turn causes a ris