自主神经功能障碍对丘脑出血患者并发应激性溃疡的作用

目的探讨丘脑出血患者自主神经功能的变化以及这种变化在应激性溃疡发生中的可能作用。方法2008年1月～2009年12月间发病24h内人住笔者所在医院神经内科的急性丘脑出血患者50例为研究对象，同期因其他疾病住院的患者50例为对照组。对以下指标进行了比较：（1）丘脑出血患者第1天，第2天和第15天后的血清儿茶酚胺浓度；（2）丘脑出血患者急性期和慢性期并发应激性溃疡的比率；（3）丘脑出血患者急性期、慢性期和对照组之间的心率变异法各频域指标。结果丘脑出血患者急性期共有20％发生应激性溃疡，血清儿茶酚胺浓度明显升高，心率变异法分析显示丘脑出血急性期HF频域成分明显升高，提示迷走神经活动增强。结论在丘脑出血急性期交感神经系统活性有所增强，而迷走神经系统活性的增强更为显著，且可能占主导地位，这种自主神经系统功能障碍在应激性溃疡的发生中可能起到一定作用。

Role of autonomic nervous disturbance in stress - induced ulcer in patients with acute cerebral hemorrhage of thalamus

Objective To explore the autonomic nerve function changes and the possible role of the change in stress - induced ulcers in patients with acute cerebral hemorrhage of thalamus by the heart rate variability analysis. Methods Between January 2008 to December 2009, 50 patients with acute cerebral Hemorrhage of thalamus admitted in neurologlc department of First People＇s Hospital of Chenzhou City and 50 cases in the control group were enrolled in our study. On the first day, the next day and the 15th day, serum catecholamine concentrations （such as：norepinephrine, epinephrine,3 - methoxy -4 -hydroxy -ethylene glycol） were measured. Through the occult blood monitoring of gastric juice and stool to determine whether the stress - induced ulcer complicated. 24 - hour Hoher ECGs were recorded in the acute stage（ during 15 days after admission） and chronic phase （15 days later after admission）. For all cases, serum catecholamine concentrations of the first day, the next day and the 15th day were compared, the proportion of stress - induced ulcer complicated between the acute stage and chronic phase were compared. The various frequency - domain indices of heart rate variability of the acute stage, chronic phase and the control group were compared. Results In patients with acute cerebral hemorrhage of thalamus, stress - induced ulcer occurred in a total of 20%, serum catecholamine concentrations significantly increased, suggesting that increased sympathetic nerve activity involved in the occurrence of stress - induced ulcers. Heart rate variability analysis showed that the parasympathetic activity in acute phase of cerebral hemorrhage of thalamus significantly increased, just as elevated HF component showed, which may be related to increased intracranial pressure. Conclusion Our results suggest that not only the sympathetic activity was enhanced in acute phase of cerebral hemorrhage of thalamus, vagal activity also increased and may be dominant. This autonomic nervous system dysfunction may play a role in the occurrence of the stress - induced ulcer.