脊髓损伤scippt课件

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1、脊髓损伤（SCI）Leadingcauses&LocationofSpinalcordinjuryMotorvehicleaccidents(47%)Falls(21%)Sports(14%)Actofviolence(14%)LocationofSCI:cervical(53%),thoracic(35%),lumbarandsacral(10%)PatternsofspinalcordinjuryCompletesyndromesNomotororsensoryfunctionIncompletesyndromesBrown-SequardSyndrome

2、CentralCordSyndromeAnteriorCordSyndromeEffectscont.Cervical:AboveC4:VentillatorC5-C7:Littlehand/armcontrolThoracic:Paraplegic:wrist/handokT1-T8:PoortorsocontrolT9-T12:BettertorsocontrolAutonomicdysreflexiaSpinalcordlesionaboveT6Hypertensionandincreasedsympatheticoutflow,flushing,swea

3、tingabovedermatomeduringincreasedvisceralinput(bladderover-distension,urination,rectaldistension,surgery,UTI)RiskofheartfailureandstrokeBladderneckcontractionduringvoidingCardiovascularComplicationsinSpinalCordInjurySpinalcordinjurycanresultinsignificantcompromiseofcardiovascularcont

4、rolduetoanimpairedautonomicnervoussystemandskeletalmuscleparalysisAcuteCardiovascularComplicationsfromtheNSCID2005ChronicCardiovascularComplicationsfromtheNSCID2005SpinalCordandAutonomicNervousSystemAnatomyCardiovascularAnatomyEvolutionofthecontrolofthecardiovascularsystemCourseofEve

5、ntsImmediatelyafterSCIoccurs,bloodpressurerisesduetoreleaseofnorepinephrinefromtheadrenalglandsandbyapressorresponsefrommechanicaldisruptionofvasoactiveneuronsandtractsinthespinalcord.Thisisfollowedbyaperiodofspinalshock(decreasedcorticalspinalandsympatheticactivityandunopposedvagalt

6、one).Overtimereflexesandspasticityreturnduetocompensatorychangesoccurinthevascularbeds,skeletalmuscle,andrennin-angiotensinaldosteronesystem.Short-andlong-termconsequences.HypotensionCardiacarrhythmiasAutonomicdysreflexiaPoikylothermiaDeepveinthrombosisCoronaryheartdiseaseExerciseres

7、ponseHypotensionDecreasedcompensatoryvasoconstrictionVenouspooling(skeletalmuscleandsplanchnicregions),venouspoolingintheextravasculartissueslowerextremities(legswelling)reducedvenousbloodreturnresultinginreducedstrokevolume,andbloodpressure.Hypotension,andespeciallyorthostasis,usual

8、lyimproveswi