脊髓损伤导致的神经源性下尿路功能障碍中未被发现的自主神经反射障碍是心脏外科入院的原因之一

I. N. Novoselova, Artem V. Bershadskii, Olga V. Popova
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引用次数: 0

摘要

背景:在俄罗斯,脊髓损伤占总损伤的 0.7-6.8%。由于新康复方案的出现,了解脊髓损伤后果发生的时间和充分诊断并发症极为重要,这可以及时发现身体某一系统出现的危及生命的情况。临床病例描述。我们介绍了一例 17 岁女孩外伤性颈脊髓损伤后神经源性下尿路功能障碍自主神经反射障碍的临床病例。在第六胸椎以上水平的外伤性脊髓损伤中,自主神经反射障碍作为自主神经功能障碍的一种变体是一种常见的并发症。这个临床病例将引起各科临床医生的兴趣,因为他们都会遇到脊髓损伤患者。病例显示,由于误解了膀胱充盈时血压升高的症状,心脏病专家对其进行了动脉高血压的观察和治疗,并将其送往心脏外科住院,计划对肾动脉狭窄进行手术治疗,而肾动脉狭窄被认为是导致血压偶发性升高的原因。由于对脊髓损伤患者是否存在自主神经功能障碍缺乏了解,可能导致了不必要的手术治疗。在与小儿心脏外科医生共同治疗该患者期间,在颈椎创伤性脊髓疾病的背景下发现了自主神经反射障碍的迹象,因此取消了降压治疗和计划中的手术干预。结论是随后,该患者接受了适当的定期膀胱导尿和抗心绞痛药物治疗,成功缓解了反射障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Unrecognised autonomic dysreflexia in neurogenic lower urinary tract dysfunction with spinal cord injury as a reason for admission to a cardiac surgical unit
BACKGROUND: In Russia, spinal cord injury occurs in 0.7–6.8% of total injuries. Due to emergence of new rehabilitation protocols, it is extremely important to know the time of occurrence of consequences of spinal cord injury and adequate diagnosis of complications, which allows timely identification of life-threatening conditions of one of the body systems. Clinical case description. We present a clinical case of autonomic dysreflexia in neurogenic lower urinary tract dysfunction after traumatic cervical spinal cord injury in a 17-year-old girl. In traumatic spinal cord injury above the level of the sixth thoracic vertebra, autonomic dysreflexia as a variant of autonomic dysfunction is a common complication. This clinical case will be of interest to clinicians of all specialties who encounter patients with spinal cord injury. It is shown that misinterpreted symptoms of increased blood pressure during bladder filling were the cause of observation and treatment by a cardiologist for arterial hypertension, as well as hospitalization in the cardiac surgery department for planned surgical treatment of renal artery stenosis, which was thought to be the cause of the episodic increases in blood pressure. Lack of knowledge about the presence of autonomic dysfunction in spinal cord injury patients may have led to unnecessary surgical treatment. During the joint management of the patient with a pediatric cardiac surgeon, signs of autonomic dysreflexia were detected against the background of traumatic spinal cord disease at the level of the cervical spine, hypotensive treatment and planned surgical intervention were canceled. Conclusion. Subsequently, an adequate regimen of periodic bladder catheterization and antimuscarinic drug therapy was prescribed, which successfully reduced the dysreflexia.
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