交感神經失常(sympathetic dysfunction、dysautonomia)、洗腎

一位67歲的洗腎女性患者，透析前收縮血壓約90-100 mmHg，洗腎中常會下降到70 mmHg，患者常沒有特別的反應不適，而且就算做了些醫療處理，血壓的回復速度也不甚理想。於是，請患者至神經科做檢查，為什麼神經的反應這麼緩慢。

檢查項目：M29-132　TILT-UP HEMODYNAMIC CHANGE
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Data:
Report of the autonomic screening tests:
Sympathetic sudomotor:
SSR performed on xxxxx showed normal responses on upper limbs and showed absent responses on lower limbs.

Cardiovagal:
Heart rate response to deep breathing was essentially normal according to the RRIV study on xxxx.

Adrenergic:
Head-up tilt (HUT) was performed for 5 minutes. Hypotension was persistent throughout the test though orthostatic BP change was not obvious. Heart rate increment was not excessive but the patient reported having transient dizziness shortly after postural change.

BP HR
Baseline: 80/47 98
1 min. : 76/52 103
2 min. : 86/54 102
3 min. : 91/57 102
4 min. : 79/57 101
5 min. : 87/57 102

Conclusion:
Results indicate a length-dependent sympathetic sudomotor and moderate adrenergic impairment with relatively preserved cardiovagal function. The pattern is more likely due to a peripheral autonomic neuropathy than a central autonomic disorder.

看到這報告實在讓我們很訝異，血壓的低以及周邊神經系統的功能性障礙。在照護這樣的病人，讓工作人員更加需特別的謹慎。