Abstract：
OBJECTIVE: This work\'s purpose was to quantify rapid sympathetic activation in individuals with spinal cord injury (SCI), and to identify associated correlations with symptoms of orthostatic hypotension and common autonomically mediated secondary medical complications.
METHODS: This work was a cross-sectional study of individuals with SCI and uninjured individuals. Symptoms of orthostatic hypotension were recorded using the Composite Autonomic Symptom Score (COMPASS)-31 and Autonomic Dysfunction following SCI (ADFSCI) survey. Histories of secondary complications of SCI were gathered. Rapid sympathetic activation was assessed using pressure recovery time of Valsalva maneuver. Stepwise multiple linear regression models identified contributions to secondary medical complication burden.
RESULTS: In total, 48 individuals (24 with SCI, 24 uninjured) underwent testing, with symptoms of orthostatic hypotension higher in those with SCI (COMPASS-31, 3.3 versus 0.6, p < 0.01; ADFSCI, 21.2 versus. 3.2, p < 0.01). Pressure recovery time was prolonged after SCI (7.0 s versus. 1.7 s, p < 0.01), though poorly correlated with orthostatic symptom severity. Neurological level of injury after SCI influenced pressure recovery time, with higher injury levels associated with more prolonged time. Stepwise multiple linear regression models identified pressure recovery time as the primary explanation for variance in number of urinary tract infections (34%), histories of hospitalizations (12%), and cumulative secondary medical complication burden (24%). In all conditions except time for bowel program, pressure recovery time outperformed current clinical tools for assessing such risk.
CONCLUSIONS: SCI is associated with impaired rapid sympathetic activation, demonstrated here by prolonged pressure recovery time. Prolonged pressure recovery time after SCI predicts higher risk for autonomically mediated secondary complications, serving as a viable index for more \"autonomically complete\" injury.
METHODS: This work was a cross-sectional study of individuals with SCI and uninjured individuals. Symptoms of orthostatic hypotension were recorded using the Composite Autonomic Symptom Score (COMPASS)-31 and Autonomic Dysfunction following SCI (ADFSCI) survey. Histories of secondary complications of SCI were gathered. Rapid sympathetic activation was assessed using pressure recovery time of Valsalva maneuver. Stepwise multiple linear regression models identified contributions to secondary medical complication burden.
RESULTS: In total, 48 individuals (24 with SCI, 24 uninjured) underwent testing, with symptoms of orthostatic hypotension higher in those with SCI (COMPASS-31, 3.3 versus 0.6, p < 0.01; ADFSCI, 21.2 versus. 3.2, p < 0.01). Pressure recovery time was prolonged after SCI (7.0 s versus. 1.7 s, p < 0.01), though poorly correlated with orthostatic symptom severity. Neurological level of injury after SCI influenced pressure recovery time, with higher injury levels associated with more prolonged time. Stepwise multiple linear regression models identified pressure recovery time as the primary explanation for variance in number of urinary tract infections (34%), histories of hospitalizations (12%), and cumulative secondary medical complication burden (24%). In all conditions except time for bowel program, pressure recovery time outperformed current clinical tools for assessing such risk.
CONCLUSIONS: SCI is associated with impaired rapid sympathetic activation, demonstrated here by prolonged pressure recovery time. Prolonged pressure recovery time after SCI predicts higher risk for autonomically mediated secondary complications, serving as a viable index for more \"autonomically complete\" injury.
摘要：
目的：这项工作的目的是量化脊髓损伤（SCI）个体的快速交感神经激活，并确定与体位性低血压和常见自主介导的继发性医学并发症症状的相关关系。
方法：这项工作是对SCI患者和未受伤患者的横断面研究。使用SCI（ADFSCI）调查后的复合自主神经症状评分（COMPASS）-31和自主神经功能障碍记录直立性低血压的症状。收集SCI继发并发症的历史。使用Valsalva动作的压力恢复时间评估快速交感神经激活。逐步多元线性回归模型确定了对次要医疗并发症负担的贡献。
结果：总计，48人（24例SCI，24例未受伤）接受了测试，SCI患者的体位性低血压症状较高（COMPASS-31，3.3vs.0.6，p<0.01；ADFSCI，21.2vs.3.2，p<0.01)。SCI后压力恢复时间延长（7.0s与。1.7s,p<0.01),尽管与立位症状严重程度相关。脊髓损伤后的神经水平影响压力恢复时间，更高的伤害水平与更长时间相关。逐步多元线性回归模型将压力恢复时间确定为尿路感染数量差异的主要解释（34％），住院史（12%），和累积次要医疗并发症负担（24％）。在所有条件下，除了肠道程序的时间，压力恢复时间优于目前评估此类风险的临床工具.
结论：SCI与快速交感神经激活受损有关，这里证明了延长的压力恢复时间。脊髓损伤后压力恢复时间延长预示自主介导的继发性并发症的风险更高，作为更多“自主完成”伤害的可行指标。
方法：这项工作是对SCI患者和未受伤患者的横断面研究。使用SCI（ADFSCI）调查后的复合自主神经症状评分（COMPASS）-31和自主神经功能障碍记录直立性低血压的症状。收集SCI继发并发症的历史。使用Valsalva动作的压力恢复时间评估快速交感神经激活。逐步多元线性回归模型确定了对次要医疗并发症负担的贡献。
结果：总计，48人（24例SCI，24例未受伤）接受了测试，SCI患者的体位性低血压症状较高（COMPASS-31，3.3vs.0.6，p<0.01；ADFSCI，21.2vs.3.2，p<0.01)。SCI后压力恢复时间延长（7.0s与。1.7s,p<0.01),尽管与立位症状严重程度相关。脊髓损伤后的神经水平影响压力恢复时间，更高的伤害水平与更长时间相关。逐步多元线性回归模型将压力恢复时间确定为尿路感染数量差异的主要解释（34％），住院史（12%），和累积次要医疗并发症负担（24％）。在所有条件下，除了肠道程序的时间，压力恢复时间优于目前评估此类风险的临床工具.
结论：SCI与快速交感神经激活受损有关，这里证明了延长的压力恢复时间。脊髓损伤后压力恢复时间延长预示自主介导的继发性并发症的风险更高，作为更多“自主完成”伤害的可行指标。
