段雅琴,毛容秋

• 1:湖南省儿童医院
• 2:广西医科大学第一附属医院

摘要(Abstract)：

目的应用心率变异性(HRV)评价急性脊髓损伤(SCI)后自主神经功能(ANS)。方法纳入符合标准的46例SCI的患者,根据其SCI的平面分为高位损伤(C_1～T_5)组和低位损伤组(T_6～T_(12))组。高位损伤组24例,其中新入院12例,康复训练后12例;低位损伤组22例,其中新入院11例,康复训练后11例。另根据美国脊髓损伤学会(ASIA)残损分级再次对患者进行分组,将其分为完全性SCI组和不完全性SCI组。其中完全性SCI组19例(新入院10例,康复训练后9例);不完全性SCI组27例(新入院13例,综合康复训练后14例)。收集新入院患者(受伤3～7 d)、康复训练后(康复训练3周,受伤后27～33 d)24 h动态心电图,分析指标:高频功率(HF)、低频功率(LF)、LF/HF、超过50 ms的个数占总(PNN50)、差值均方的平方根(rMSSD)、均值标准差(SDANN)。结果新入院患者中,高位损伤组较低位损伤组LF/HF下降显著,高频指标增高更显著,完全性SCI组与不完全SCI组伤相比,HRV无论高频部分还是低频部分都不同程度降低(P<0.05);康复训练后高位损伤组与低位损伤组相比,LF/HF显著降低;完全性SCI组与不完全性SCI组相比,HRV无论高频部分还是低频部分不同程度降低;康复训练后与新入院对比,高位损伤组SDANN显著升高,不完全性SCI组SDANN显著升高,但其他各项指标变化不显著。结论急性期SCI损伤的平面越高,损伤程度越严重,此时患者自主神经系统受损越发严重;伤后1个月时完全性SCI自主神经功能恢复较差,而损伤平面较高的患者难达到交感迷走平衡,损伤平面高的患者较损伤平面低的患者副交感神经更占优势,不完全性SCI患者自主神经恢复优于较完全性SCI患者。

关键词(KeyWords)： 心率变异性;脊髓损伤;自主神经;急性期

Abstract:

Keywords:

基金项目(Foundation): 湖南省残疾人康复科研项目(编号:2019XK002)

作者(Author): 段雅琴,毛容秋

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