Clinical Study on Evaluation of Autonomic Nervous Dysfunction Based on Imaging Urodynamic Examination with Slow Filling and Synchronous Blood Pressure Monitoring in the Patients with Cervicothoracic Spinal Cord Injury

Qingqing Li,Hui Chen,Xinghua Yang,Xihui Xiao,Maping Huang,Weibin Zeng,Shuqing Wu

doi:10.4236/oju.2021.114012

Abstract

Objective: Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to evaluate autonomic nervous function. Patients and Method: 48 patients with dysuria after cervicothoracic SCI were selected. Before, during and after imaging urodynamic examination with slow filling in supine position, blood pressure and ECG were monitored simultaneously. The symptoms of sweating, shivering, headache, flushing and chills were observed and recorded. The study of the relationship among the changes of blood pressure, heart rate and urodynamic indexes and the above symptoms was analyzed. Results: They were divided into three groups: group A (no obvious abnormality), group B (hyperactivity) and group C (hypoactivity) according to their BP, HR and existing the symptoms or not. Conclusion: The incidence of autonomic dysfunction in the high level SCI patients with dysuria was very high (79.17%), most of them were hyperactivity, and a few were low function. The changes of SBP and DBP in the hypoactivity group all appeared an increasing and then declining trend, while the change of HR in the low function one was lower than normal and decreased continuously. The main inducements of AD are neurogenic detrusor overactivity, detrusor sphincter dyssynergia, elevated abdominal pressure and abnormal bladder sensitivity. The asymptomatic patients had a higher occurrence rate (43.75%). Only by imaging urodynamic examination with slow filling and synchronous blood pressure monitoring, can autonomic nervous function of the patients be evaluated safely, objectively, early and accurately.

Highlights

The Patients with dysuria of high level spinal cord injury (SCI) above T6 often have autonomic nervous dysfunction, such as sudden significant increasement of blood pressure, tachycardia, or transient hypotension, bradycardia, and or accompanied by sweating, shivering, headache, blushing, chills, hyperspasmia of muscles below the injury level and other symptoms [1] [2]
Severe cases have the risk of cerebral hemorrhage [3], retinal hemorrhage [4], or seizures, and even cardiac arrest [5], which is one of the most serious complications after SCI
How can the blood pressure and heart rate change dynamically when autonomic nerve dysfunction occurs in such patients? What is the relationship between it and bladder filling? What are the corresponding mechanisms and main incentives? How to evaluate autonomic nervous function safely and scientifically? The above issues urgently need to be studied and discussed

Summary

Introduction

The Patients with dysuria of high level spinal cord injury (SCI) above T6 often have autonomic nervous dysfunction, such as sudden significant increasement of blood pressure, tachycardia, or transient hypotension, bradycardia, and or accompanied by sweating, shivering, headache, blushing, chills, hyperspasmia of muscles below the injury level and other symptoms [1] [2]. Severe cases have the risk of cerebral hemorrhage [3], retinal hemorrhage [4], or seizures, and even cardiac arrest [5], which is one of the most serious complications after SCI. It may even aggravate the neurological symptoms of the patients [6] and affect the rehabilitation process. It is very important to clarify the change rule of autonomic nerve dysfunction in the patients with dysuria after high level SCI, to explore its causes, to quantify autonomic nerve function of the patients scientifically, to find a safe, objective, early and accurate method to evaluate autonomic nerve function of them in clinic

Results

Discussion

Conclusion