autonomic nerve function test

The onset of psychosomatic diseases, in general, is related to the instability of the autonomic nervous system, and most of the psychosomatic diseases occur in organs that are autonomically innervated. Therefore, autonomic function tests have a certain help in the diagnosis of psychosomatic diseases. Commonly used examination methods include eye center reflex, lying test, vertical hair reflex, histamine test, and body position change test. Basic Information Specialist classification: neurological examination classification: neuroelectrophysiology Applicable gender: whether men and women apply fasting: not fasting Tips: Do not do strenuous exercise before checking. Normal value First, the eye reflex can be reduced by 10-20 times per minute. Second, the vertical test of the normal person from the lying position to the standing position pulse rate increased by no more than 10-12 times / min. Third, vertical hair reflexes in normal people after 4 to 5 seconds after a vertical hair reaction (visible vertical muscle contraction, hair follicles bulge like chicken skin), 7 to 10 seconds is most obvious, 15 to 20 seconds disappear. Fourth, histamine test (1) The blood pressure increased by >8.0/5.3 kPa (60/40 mmHg) after the injection of histamine, and the duration was >5 minutes. (2). The highest blood pressure after the injection of histamine was increased by >2.7-13.3KPa (20/10mmHg) for >5min. (3) Typical symptoms appear. Normally only one or three of them do not appear. V. Postural change test The normal person's pulse rate from the lying position to the standing position does not increase by more than 10-12 times/min. From the standing position to the lying position, the pulse rate is slowed down by no more than 10 to 12 times/min. Clinical significance Abnormal result First, the eye reflex more than 12 times / min prompted the parasympathetic (vagus) nerve function enhancement, vagus nerve paralysis did not respond. If the compression pulse rate is not slowed down but accelerated, it suggests hypersympathetic function. Second, the lying test, such as from the lying position to the standing position pulse rate increased more than 10-12 times / divided into sympathetic nerve excitability. Third, the vertical hair reflex is governed by sympathetic segmental, that is, the neck 8 ~ chest 3 with the face and neck, chest 4 ~ chest 7 with the upper limb, chest 8 ~ chest 9 with the trunk, chest 10 ~ waist 2 with the lower limbs. According to the location of the reaction, it can assist in the localization diagnosis of sympathetic dysfunction. Fourth, histamine test (1) Normal person is negative in this test. (2) pheochromocytoma, mostly positive, the positive rate can reach 50%-80%. After injecting histamine, there was a brief mild drop in blood pressure, then it rose rapidly, peaked more than 2 minutes, and clinical symptoms appeared. At this time, if benzyl oxazoline is injected, the blood pressure drops rapidly, which is more helpful for diagnosis. The content of urinary catecholamine after injection of histamine was significantly increased compared with that before injection. (3) Some patients with pheochromocytoma may be repeatedly negative for this test, which may be related to the use of antihypertensive drugs. Five, posture change test 1. The sympathetic function is increased by >24 beats/min, or the heart rate is above 100 beats/min-120 beats/min. 2. The vagus nerve function is reduced by ±12 times/min. 3. Upright hypotension is positive for standing reflex. (1) Both systolic and diastolic blood pressures decrease when standing up, and the heart rate changes lightly, suggesting that the central regulation function is abnormal. (2) The systolic blood pressure drops when standing up, and the diastolic blood pressure rises, which indicates that the peripheral blood vessels are dilated, the blood volume of the returning heart is reduced, and the blood output of the heart is decreased. 4. Heart failure, the test results are the same as 1. People who need to be checked Autonomic dysfunction, orthostatic hypotension, unexplained syncope. Positive results may be diseases: reactive psychosis, hyperhidrosis, elbow syndrome considerations Taboo before inspection: 1. Do not do strenuous exercise before checking. 1. Antihypertensive drugs, sedatives, anesthetics and narcotic analgesics were stopped before the histamine test for 2 and 3 days. 2, histamine test due to rapid rise in blood pressure in a short period of time, there is a risk of cerebrovascular disease, myocardial infarction, so the test should be prepared to rescue drugs, equipment, and close observation. 3, the histamine test should be done before the cold pressure test, in order to control. Note when checking: 1, adverse reactions can occur in the histamine test: headache, flushing, blood pressure, heart rate, this is a normal phenomenon, do not have to panic. 2. During the eye-reflection examination, if the doctor uses the right middle finger and forefinger to press on both sides of the eyeball, if you feel pain, you should inform the doctor in time so that the doctor can adjust the examination. 3, the body and mind should be relaxed during the examination to prevent pulse and pulse rate increase due to excessive stress, affecting the test results. 4. If the patient has syncope during the reclining test, the supine position should be restored immediately and appropriate treatment measures should be taken. 5, severe vagus nerve hyperthyroidism, heart conduction block can occur in the standing test, but the incidence is very small, and can recover. Inspection process First, eye reflex: 嘱 patients lying on their backs, eyes closed, the doctor with the right middle finger and index finger placed on both sides of the patient's eyeball, gradually exert pressure, but can not make the patient feel pain, after 20-30s pressure count 1min pulse times, normal every The minute pulse can be reduced by 10-20 times, and the decrease of 12 times/min or more indicates that the vagus nerve function is enhanced, and the decrease of 18-24 times/min indicates that the vagus nerve function is significantly hyperactive. If the pulse rate does not decrease or increase after compression, it is called inversion reaction, suggesting sympathetic hyperfunction. Second, the vertical test: the supine position counts the pulse rate for 1 minute, then stands up straight, and then counts the pulse rate for 1 minute. For example, the pulse rate from the lying position to the standing position is increased by more than 10-12 times/the sympathetic nerve excitability is enhanced. Third, vertical hair reflex: sculpt or stimulate the skin of the patient's neck, chest and other parts with ice. Normal people have a vertical hair reaction after 4 to 5 seconds (visible vertical muscle contraction, hair follicle bulge like chicken skin) It is most obvious at 7 to 10 seconds and disappears at 15 to 20 seconds. Fourth, histamine test: 1. Antihypertensive drugs, sedatives, anesthetics and narcotic analgesics were stopped before the test for 2 and 3 days. 2. The patient is quietly supine until the blood pressure is stable, or the blood pressure is restored to the basal level after the cold compression test, and the blood pressure after stabilization is recorded as a control. 3. Intravenous infusion of physiological saline to keep the fluid path unobstructed, and then take the histamine matrix 0.025mg-0.05mg (histamine phosphate 0.07mg-0.14mg), dissolved in 0.5ml physiological saline and quickly injected from the infusion tube. 4. After injecting histamine, measure blood pressure on the contralateral upper arm, measure once every 30s, continuously measure for 5 minutes, then change to 1 minute per minute, then measure for 10 minutes, measure 1 time, minute, or return blood pressure to the basic level. until. 5. Collect urine for 1 h before and after injection of histamine, and measure the content of catecholamine. The result is judged: 1. After injection of histamine, the blood pressure increased by >8.0/5.3 kPa (60/40 mmHg), and the duration was >5 minutes. 2. The highest blood pressure after the injection of histamine was increased by >2.7-13.3KPa (20/10mmHg) for >5min. 3. Typical symptoms appear. Those with the above 1, 3 or 2, 3 are positive for the test. Five, posture change test 1. Horizontal reflection: The patient was rested for 20 minutes, and the upper arm blood pressure and pulse were measured once every 3 min to 5 min, or the blood pressure, heart rate, and electrocardiogram were simultaneously recorded by a multi-channel recorder. After the blood pressure and heart rate are stable, the patient suddenly stands and continues to monitor the above parameters until the blood pressure returns to the original level. After standing, the systolic blood pressure decreased by 2kPa-2.67kPa (15mmHg-20mmHg), or the heart rate increased by 6 times/min-24 times/min; the value was lower than the above value. After standing, the systolic blood pressure drops > 2.67 kPa (20 mmHg), or the heart rate increases rapidly > 24 times / min, or there is syncope as a strong positive. 2. Vertical reflex: The patient is erect, the monitoring parameters and methods are the same as above, and suddenly lying flat after being stabilized, the above parameters are continuously monitored until the blood pressure is stable or restored to the standing level. After lying down, the pulse was reduced by 8 times/min-12 times/min, and >12 times/min was strongly positive. Not suitable for the crowd 1, those who are particularly weak, severe organ failure. 2, for the elderly with slow heart rate, high myopia, glaucoma or other eye diseases are contraindicated eyesight reflex this check. 3, the elderly, coronary heart disease, cerebrovascular disease, blood pressure > 22.7 / 13.3kPa (170 / 100mmHg) is prohibited to do histamine test. Adverse reactions and risks Generally no adverse reactions.

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