腰2交感阻滞联合牛痘疫苗接种家兔炎症皮肤提取物治疗糖尿病神经病变的观察

目的:评价腰2交感阻滞联合牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平)治疗糖尿病神经病变的疗效。方法:2型糖尿病神经病变患者60例,随机分两组,一组腰2交感阻滞+神经妥乐平(实验组),另一组仅行腰2交感阻滞(对照组)。两组均在C型臂下行双侧腰2交感神经阻滞,神经妥乐平口服为神经妥乐平片(4.0 U/片),每次2片,每天2次。治疗1、4、8周后观察疼痛、麻木改善情况。结果:治疗8周后,两组的痛觉VAS评分皆明显降低,实验组总有效率83.3%,对照组总有效率76.7%,两组无统计学意义(P>0.05);而两组的麻木改善总有效率存在明显差异:实验组63.3%,对照组26.7%(P<0.01)。结论:腰2交感阻滞联合神经妥乐平治疗糖尿病神经病变,与单用腰2交感阻滞相比,二者均能镇痛,但前者对麻木症状改善显著优于后者。     

脂肪组织的两种神经调控途径及其相互关系

脂肪组织可以通过自主神经和神经体液两种途径作用于中枢,调节机体能量代谢.褐色脂肪组织主要受交感神经支配;白色脂肪组织除了受交感神经支配外,还有可能存在副交感神经及感觉神经支配,中枢神经系统很可能通过交感和副交感神经之间的平衡调节白色脂肪组织的脂肪动员,从而调节机体能量代谢.机体神经体液因子中的体脂信号瘦素和胰岛素通过神经肽Y/刺鼠相关蛋白和阿片黑皮质素原/可卡因苯丙胺调节转录肽神经元调节机体能量代谢;营养素和脑肠肽作用途径分两类,一类通过副交感途径,另一类通过神经肽Y/刺鼠相关蛋白途径.自主神经和神经体液这两种途径相互作用,构成一个整体的网络调节系统,其中MC3/4-R很可能是瘦素-交感神经组织特异性的物质基础.     

腹腔镜下宫颈癌保留神经平面广泛子宫切除术的临床效果

目的:探究腹腔镜下宫颈癌保留神经平面广泛子宫切除术的临床应用效果。方法:选取2016年3月至2017月7月116例在本院接受宫颈癌治疗的患者为研究对象,根据手术方法进行分组,47例不实施保留神经平面广泛子宫切除术的患者为对照组,69例实施宫颈癌保留神经平面广泛子宫切除术患者为观察组,比较两组患者的手术指标、直肠、膀胱恢复情况及不良反应。结果:观察组手术时间、手术出血量高于对照组,住院时间低于对照组(P<0.05);观察组排气时间、排尿间隔时长、尿管留置时间均低于对照组,而最大尿流率高于对照组,差异具有统计学意义(P<0.05);观察组不良反应率为8.70%,对照组不良反应为40.43%,观察组低于对照组,差异具有统计学意义(P<0.05)。结论:腹腔镜下宫颈癌保留神经平面广泛子宫切除术手术时间长、出血量增加,但是安全可靠,术后恢复快。     

尿毒症患者周围神经的电生理研究

目的研究尿毒症患者周围神经的电生理表现。方法选择尿毒症患者24 例及同期健康对照者19 例,采用常规表面电极对胫后神经、腓总神经、腓肠神经及皮肤交感反应进行检查,观察尿毒症患者周围神经的电生理表现。结果两组运动传导、感觉传导及交感皮肤反应潜伏期均有显著性差异(P<0.05)。电生理表现主要为F 波的潜伏期延长,传导速度减慢,潜伏期延长,感觉纤维受累重于运动纤维。结论尿毒症性周围神经病是尿毒症最常见的并发症之一,神经电生理的异常明显早于临床症状,周围神经的电生理检查对该病的诊断及评价具有重要意义。     

腹腔镜下保留盆腔神经宫颈癌根治术对膀胱功能影响分析

目的评价腹腔镜下保留盆腔神经宫颈癌根治术实行于宫颈癌患者中对其膀胱功能的影响。方法选取2017年10月～2018年12月我院治疗的宫颈癌患者66例,按照抽签法分为观察组和对照组各33例。观察组予以腹腔镜下保留盆腔神经宫颈癌根治术,对照组予以腹腔镜下广泛子宫切除术,计算两组留置导尿管天数、残余尿量、手术耗时、术后肛门恢复排气用时、术前及术后最大逼尿肌压、最大尿流率、不良排尿情况。结果观察组留置导尿管天数、残余尿量低于对照组,差异有统计学意义(P0.05);观察组手术耗时长于对照组,术后肛门恢复排气用时短于对照组,差异均有统计学意义(P0.05);观察组术后最大逼尿肌压、最大尿流率高于对照组,差异均有统计学意义(P0.05);观察组张力性尿失禁例数、排尿困难例数、腹压排尿例数、尿不尽例数、排尿用时延长例数均少于对照组,差异均有统计学意义(P0.05)。结论对宫颈癌患者实施腹腔镜下保留盆腔神经宫颈癌根治术可减少对膀胱功能的影响。     

腹腔镜下保留盆腔自主神经根治性子宫切除术的临床研究

目的探讨腹腔镜下保留盆腔自主神经根治性子宫切除术对降低膀胱功能障碍并发症作用以及其安全性和可行性。方法对2008年9月～2012年9月在本院住院1A2—182期宫颈癌患者42例实施腹腔镜下保留神经的根治性子宫切除术（LNSRH组）,42例实施腹腔镜下子宫根治术而未保留盆腔自主神经（LRH组）。观察2组术中的出血量、手术时间及术后膀胱功能恢复情况等指标。结果所有患者均完成了保留盆腔自主神经根治性子宫切除术。LRH组仅1例患者术中发生膀胱损伤并在腹腔镜下完成了修补。LNSRH组的手术时间为（240±34）min,明显长于LRH组的（186±35）min（P〈O．05）;2组术中出血量、切除盆腔淋巴结的数目、切除宫旁组织长度、阴道长度比较均无显著差异（P〉O．05）;LNSRH组的术后尿管拔除时间为（7．4±2．5）d,明显短于LRH组的（17．6±7．6）d（P〈0．05）。结论腹腔镜下保留盆腔自主神经的根治性子宫切除术能够降低手术对膀胱功能的损伤,促进术后膀胱功能的恢复。     

乳腺癌术中保留肋间臂神经的临床价值

目的探讨乳腺癌腋窝淋巴结清扫术中保留肋间臂神经的临床价值。方法49例Ⅰ、Ⅱ、Ⅲa期乳腺癌患者中,30例保留肋间臂神经,19例切除肋间臂神经,术后测试患侧上臂内侧感觉并随访。结果保留肋间臂神经30例术后患侧上臂内侧感觉正常27例,异常3例,19例切除肋间臂神经术后18例有感觉异常。随访2年后保留肋间臂神经的30例患者未出现局部复发。结论在乳腺癌术中保留肋间臂神经可明显减少术后患侧上臂内侧感觉障碍的发生,不影响手术的彻底性。     

保留胸前神经和肋间臂神经的乳腺癌改良根治手术的疗效观察

目的分析乳腺癌改良根治手术中保留胸前神经和肋间臂神经临床疗效。方法将2012年3月至2013年10月经治疗的80例乳腺癌患者随机分为两组,观察组和对照组各40例,其中前者进行乳腺癌改良根治术中保留胸前神经和肋间臂神经,而后者在术中不保留胸前神经和肋间臂神经,对比观察两组手术时间、复发及肿瘤转移率(骨转移、侧腋窝转移)、不良反应(上肢水肿、上臂运动障碍、上臂术后感觉异常、胸大肌萎缩)发生率。结果两组手术时间比较,观察组手术时间长于对照组(85.0±15.0 min vs.70.5±10.0 min),差异有显著性(P0.05),术后复发及肿瘤转移率率、不良反应率明显高于对照组,组间比较差异有显著性(P0.05)。结论保留胸前神经和肋间臂神经的乳腺癌改良根治手术可显著降低术后复发率和转移率,减少不良反应及并发症的发生,具有临床应用价值。     

心衰时神经内分泌异常治疗理论及评价

充血性心力衰竭(Congestive Heart Failure,CHF)发病机制已由心肾机制、心脏周围循环机制发展到神经体液机制.认为神经内分泌系统异常为CHF的病理生理特征,并强调在心衰临床症状出现前即有神经内分泌活动异常,而其中交感神-肾上腺髓质系统与肾素-血管紧张素-醛固酮系统(Renin Angiotensin Aldosterone,R0AAS)发挥着重要病理生理作用,结果终将导致低心排血量、高循环阻力和循环瘀血的恶性循环,使病情进行性加重.故纠正心衰时神经内分泌异常,必然成为治疗心衰的根本措施.本文旨在从理论上系统论述β受体阻滞剂与血管紧张素转换酶抑制剂(AngiotensinConverting Enzyme Inhibitors,ACEI)作用机制及应用情况,并对其治疗心衰的明显益处作一评价.     

腮腺肿瘤术中保留耳大神经分支的临床分析

目的分析腮腺肿瘤手术中保留耳大神经分支的临床效果。方法回顾2011年7月-2013年6月63例腮腺肿瘤手术中耳大神经保留及术后术区皮肤感觉随访情况。63例患者中行耳大神经分支保留手术55例,其中保留耳大神经耳后支7例,保留耳后及耳垂支41例,保留耳前、耳垂及耳后三大主要分支7例;8例未保留耳大神经。结果未保留耳大神经患者术后耳垂及耳垂周围皮肤长期麻木。保留耳大神经分支的55例患者中49例出现暂时性术区皮肤感觉减退,1~3个月恢复正常,6例术后耳后乳突区、耳垂几乎无明显麻木。结论腮腺肿瘤术中保留耳大神经分支,可避免或减轻患者术区麻木、提高患者术后生活质量。保留耳垂及耳后分支具有手术操作可行性,疗效确切。     

Neuro-pharmacologic studies on neurogenic bladder after radical hysterectomy

Miction function of patients who had had radical hysterectomy was investigated neuro-pharmacologically. The patients were divided into two groups according to the operation, with or without preservation of the plexus pelvicus, and bladder and urethral functions were compared by the bethanechol test and phentolamine test. The group with transected plexus pelvicus showed neurogenic bladder with impairment of functions of parasympathetic and sympathetic nerves and the preserved group showed much less impairment in functions of both nerves.     

Neurovegetativum, Blockaden und manuelle Medizin

The ubiquitous distribution of the vegetative nervous system (VNS), the functions of which control all acts in the body, e.g. in the situation of being in homeostasis or homeodynamics, as well as in the case of diseases, makes the diagnostic and therapeutic access to the VNS possible and supports healing in combination with manual medicine and neurotherapy. The definition of a disease or rather a blockade of the spinal column or another joint is basically determined by the stimulus response of the VNS, which can disrupt the balance between the sympathetic and parasympathetic nervous systems depending on the duration and intensity of the stimulus and for this reason can lead to a disorder of an organ or a whole organ system. If a stimulus or irritation lasts long enough and overloads the corresponding regulation mechanism between the sympathetic and parasympathetic nervous systems it will lead to a manifestation of the disease or rather to blockade of the respective region of distribution depending on the predominance of one vegetative branch or the other. Because of the well-developed network of the stimulation conduction system the stimulus could have happened anywhere. The response is not necessarily only at the place where the stimulus occurred and it can also be expected to have occurred somewhere else. Permanent stress (irritation of the sympathetic nervous system) causes a constant reduction of the blood circulation to various organs, back muscles, ligaments and bones. This will lead to organic diseases in the future which can persist even long after the stress situation has passed.     

Nerve regulation of the heart rhythm in patients with chronic inflammation

AIM: To study nervous regulation of cardiac rate variability (CRV) in patients with chronic inflammation (CI). MATERIAL AND METHODS: The computer version of CRV assessment was used in the study of 79 CI patients and 40 healthy controls. RESULTS: Nervous regulation of cardiac rhythm in CI patients at rest is characterized with imbalance of autonomic nervous system functions: potent sympathetic effects and weak parasympathetic effects in patients with herpes simplex virus infection; stability of parasympathetic influences with sympathetic variability in patients with chronic bronchitis. Using the emotional and physical tests it was found that there is a deficiency of sympathetic effects in patients with chronic bronchitis and parasympathetic dysfunction in patients with HSV infection. CONCLUSION: It is thought valid to include vegetotropic drugs in therapy of patients with chronic inflammation.     

Heart rate recovery in migraine and tension-type headache

OBJECTIVE: There are reports proposing that migraine and tension-type headache (TTH) may affect the autonomic nervous system (ANS). Abnormalities in both sympathetic and parasympathetic nervous system have been suggested in migraineurs. However, in TTH, reports on the ANS function are limited and only associated with sympathetic system. Techniques for evaluating parasympathetic activity are more limited when compared with sympathetic function. Hence, the aim of the study was to measure heart rate recovery (HRR), an index of vagal activity, in migraine, TTH, and control subjects. METHODS: Forty-seven episodic migraine, 10 episodic TTH, 11 chronic TTH, and 25 control subjects underwent exercise tolerance test according to modified Bruce protocol, and HRR at 1 minute and 3 minutes (HRR1 and HRR3) were calculated. RESULTS: The HRR 1 and 3 were found to be similar in 3 groups of subjects. However, resting heart rate of migraine and chronic TTH were found to be higher than episodic TTH, but not different from the control group. CONCLUSION: These results suggest that parasympathetic function has not been affected in migraine and TTH patients. However, sympathetic tonus, which is evaluated by resting heart rate, is higher in migraine and chronic TTH than in episodic TTH.     

Systemic cardiovascular effects of intracranial disorders: implications for nursing care

Autonomic nervous system imbalances are implicated in the genesis of cardiovascular systemic effects of brain disorders. With many potentially lethal cardiovascular problems, sympathetic predominance over parasympathetic stimuli prevails. Autonomic nervous system imbalances may be caused not only by over-activity or depression of either the sympathetic or parasympathetic nervous systems but also by unchanged activity of one and depression or overactivity of the other. Because the autonomic nervous system has representation in all levels of the brain, it becomes apparent why diverse brain disorders could trigger these effects. It is possible that more than one systemic effect may occur in a patient during the course of an acute brain insult. The hypothalamus, with its anterior parasympathetic nervous system centers and posterolateral sympathetic nervous system centers, plays an important role in the autonomic nervous system. Its role has been more clearly identified than other portions of the central autonomic system. Nursing implications for the care of patients with cardiovascular effects have been identified. Many of these effects may go unnoticed in the early stages because of lack of knowledge; consequently, opportunities for early therapeutic interventions are lost to the detriment of the patient. These effects, when unrecognized and untreated, compound the primary and secondary intracranial insults. They can contribute to the rapid deterioration and demise of the patient, especially if he is unstable and has lost intracranial compliance, autoregulation, and vasomotor tone. Because many of these patients, have had no evidence of cardiovascular problems prior to the acute brain insult, it behooves nurses to familiarize themselves with the signs and symptoms of the systemic cardiovascular effects and appropriately intervene to prevent or offset the complications they produce in the acutely brain-damaged patient.     

Autonomic pathophysiology in heart failure patients. Sympathetic-cholinergic interrelations.

We conducted this study in an effort to characterize and understand vagal abnormalities in heart failure patients whose sympathetic activity is known. We measured sympathetic (peroneal nerve muscle sympathetic recordings and antecubital vein plasma norepinephrine levels) and vagal (R-R intervals and their standard deviations) activities in eight heart failure patients and eight age-matched healthy volunteers, before and after parasympathomimetic and parasympatholytic intravenous doses of atropine sulfate. At rest, sympathetic and parasympathetic outflows were related reciprocally: heart failure patients had high sympathetic and low parasympathetic outflows, and healthy subjects had low sympathetic and high parasympathetic outflows. Low dose atropine, which is known to increase the activity of central vagal-cardiac motoneurons, significantly increased R-R intervals in healthy subjects, but did not alter R-R intervals in heart failure patients. Thus, our data document reciprocal supranormal sympathetic and subnormal parasympathetic outflows in heart failure patients and suggest that these abnormalities result in part from abnormalities within the central nervous system.     

Abnormalities of autonomic nervous systems in intoxications, including alcohol and drugs]

Disorders in the autonomic nervous system occur frequently in cases with alcoholism or various intoxications. Drugs, especially those related to neurotransmitters may induce complicated symptoms in the sympathetic or parasympathetic nervous system. Some of these symptoms are accompanied by peripheral neuropathy. Intoxication, especially alcoholism is often are combined with a malnutrition, such as avitaminosis. Dysautonomic symptoms change successively; at an early stage, drugs or toxins stimulate sympathetic or parasympathetic receptors, while the same receptors are inhibited at a later stage when the concentration of the substances rises in the blood. Frequent stimulations of the same receptor may produce change in the sensitivity of receptors, decreased metabolism or addiction. These changes suggest that a different approach towards the acute and chronic autonomic disorders caused by intoxications is needed.     

Aging of the autonomic nervous system

Aging is associated with structural and functional changes in the autonomic nervous system (ANS), which innervates the whole body, and its altered function may influence almost all body systems. Changes related to aging are found in autonomic nerves and ganglia, and ANS controlled functions including cardiovascular functions. Much of the current knowledge about age-related changes in sympathetic nervous function is derived from studies of circulating catecholamine levels, norepinephrine kinetics and microneurographic recordings from sympathetic nerves of skeletal muscle. Significant evidence suggests that basal plasma noradrenaline levels increase with age. These data indicates that healthy aging is associated with elevated basal sympathetic nervous activity. In contrast, the reactivity of the sympathetic and the parasympathetic nervous activity are reduced with aging.     

Two cases of symptomatic cluster-like headache suggest the importance of sympathetic/parasympathetic balance

Despite several reports on symptomatic cluster-like headache, there is no clear explanation of how different lesions thought to be causative are related to cluster-like headache. On the basis of two additional cases of symptomatic cluster headache, we discuss the possibility that an acute imbalance of the autonomic nervous system, namely a net overactivity of the parasympathetic system, may be able to trigger these headache attacks in patients who probably have an additional individual predisposition to react with a cluster-like headache. Such an imbalance can be due to an increase in parasympathetic tone (e.g. stimulation of parasympathetic fibres) or to a reduction of the sympathetic tone (e.g. a lesion of the sympathetic fibres).     

Autonomic mechanisms regulating myocardial contractility in conscious animals

In this review some of the issues and controversies involved in the neural control of the myocardial inotropic response to stress have been discussed. For example, it is surprising that either direct or reflex activation of the sympathetic nerves induces a relatively small increase (20-40%) in the left ventricular inotropic state when compared with the three-five-fold increase associated with maximal dynamic exercise. Studies contrasting the levels of circulating catecholamines with the left ventricular inotropic responses induced by hemorrhage, exercise and exogenously administered catecholamines, suggest that the catecholamine concentration at the synaptic cleft is the primary determinant of the left ventricular inotropic response. Although parasympathetic neural activation alone appears to have little direct influence on the left ventricular inotropic state and central nervous system integration of the autonomic nervous system usually insures there is a reciprocal relationship between sympathetic and parasympathetic neural activity, the potential for parasympathetic inhibition of the response to sympathetic or sympathomimetic augmentation of the intropic response exists. The importance of sympathetic-parasympathetic nervous system interaction in physiologic and pathologic conditions has yet to be defined. It is this type of knowledge of the interactions of reflex pathways which will be critical to the full understanding of autonomic reflex control of myocardial performance under physiologic and pathologic conditions.