SCI complications

1. Rehabilitation 國考題_SCI
complications
R 吳易澄

3. SCI併發症

4. SCI併發症
其實我也會
AD…

5. • 下列有關脊髓損傷患者自律神經反射異常
（autonomic dysreflxia）的敘述，何者最
正確？(98-1-66,94-1-95)
1.在剛受傷的前三個月，最容易出現症狀
2.胸髓損傷患者發生機率最高
3.發作時頭痛、冒汗、血壓升高
4.最常見的誘發原因是情緒激動、緊張

7. AUTONOMIC DYSREFLEXIA

8. Onset
• syndrome of massive imbalanced reflex
sympathetic discharge in patients with SCI above
the splanchnic outflow (T5–L2).
• May appear within 2–4 weeks postinjury.
• Classically occurs in patients with neurological
complete SCI, although it may occur in patients
with incomplete SCI.

9. Most common causes
– Bladder: blocked catheter
– Bowel: fecal impaction
– Abdominal emergency (appendicitis, cholecystis, Pancreatitis)
– Labor
– Pressure ulcers
– Fractures
– Ingrown toenails
– Orgasm
– Urinary tract infections
– Epididymitis
– Bladder stones
– Gastric ulcers

10. Signs and Symptoms
– Headache
– Sweating above level of SCI
– Flushing above level of SCI
– Elevated blood pressure
– Bradycardia
– Piloerection
– Pupillary constriction
– Sinus congestion

11. • 頸髓損傷患者容易發生姿勢性低血壓，下
列方法可以改善其症狀，何者錯誤？(94-1-
93)
• 攝取充分的鹽分與水分
• 服用α腎上腺阻斷劑（α-adrenergic
blockers
• 穿彈性襪、綁束腹（abdominal corset ）
• 坐輪椅時，腿部抬高

12. Orthostatic hypotension
Treatment
• Reposition—Trendelenburg/– recliner wheelchair
• Elastic stocking/abdominal binder/ace wrap LE
• Accomodation–use of tilt table
• Fluid resuscitation: increase fluid intake
• Pharmacological
– Salt tablets 1 gram QID
– Midodrine (alpha 1 adrenergic agonist): 2.5–10 mg TID
– Florinef® (mineralocorticoid): 0.05–0.1 mg QD
• Use caution: once orthostatsis improves, the patient
may be at risk for autonomic dysreflexia.

13. • 一位第七節頸脊髓損傷的病人，臥病1 年
之後，開始接受復健訓練。請問此病人首
先必須克服的問題是什麼？(94-1-93)
• 姿勢性低血壓
• 肢體麻痺
• 關節攣縮
• 解尿問題

14. Treatment
• Reposition—Trendelenburg/– recliner wheelchair
• Elastic stocking/abdominal binder/ace wrap LE
• Accomodation–use of tilt table
• Fluid resuscitation: increase fluid intake
• Pharmacological
– Salt tablets 1 gram QID
– Midodrine (alpha 1 adrenergic agonist): 2.5–10 mg TID
– Florinef® (mineralocorticoid): 0.05–0.1 mg QD
• Use caution: once orthostatsis improves, the patient
may be at risk for autonomic dysreflexia.

17. • 下列各種病患中，體溫調節障礙最明顯的
是： (98-1-64)
• 第六頸髓損傷患者
• 第十胸髓損傷患者
• 薦椎脊柱裂（ spina bifida）患者
• 胸髓空洞症（ syringomyelia ）患者

18. Important Levels to Remember
• T6 and above: individuals with SCI are considered to be
at risk for
– Autonomic Dysreflexia
– Orthostatic Hypotension
• T8 and above: if lesion above T8, patient cannot
regulate and maintain normal body temperature.
– (Note: an easy way to remember this level is to
spell the word temp eight ture.)
– Central temperature regulation in the brain is
located in the hypothalamus.

19. • 某病患因為重病臥床太久，薦骨部位出現褥瘡
，檢測時發現表皮有約2 公分平方的水泡，邊
緣泛紅，未看到真皮層的損傷或化膿。其褥瘡
依據照護及研究（health care policy and
research）分類是屬於那一級？(99-2-61)
1. stage 0
2. stage I
3. stage II
4. stage III

21. MECHANISMS OF DEVELOPING A
PRESSURE ULCER
• 1. Ischemia: lack of blood supply to the tissue
– Frequently associated with hyperemia in the surrounding tissue.
– Increased local O2 consumption occurs.
• 2. Pressure:
– Prolonged pressure over bony prominences, exceeding
supracapillary pressure (70 mmHg pressure) continuously for 2
hours results in occlusion of the microvessels of the dermis with
subsequent tissue ischemia.
• 3. Friction (Shearing Forces):
– Friction mechanically separates the epidermis immediately above
the basal cells.

22. • 長期側躺的病人最常發生褥瘡的位置在下
列何部位？(100-2-69)
1.髂嵴（iliac crest）
2.股骨大粗隆（greater trochanter of femur ）
3.肩部（shoulder）
4.腳踝（ankle）

24. • 下列關於利用肌肉皮瓣修補薦部壓瘡手術
後的注意事項，何者正確？(99-2-61)
1.術後應立即開始運動計畫，以免皮瓣萎縮
、關節僵硬
2.臥床時，床尾應該升高超過15 度
3.臥床時，床頭角度不要高於15 度
4.可以下床後2 週內應使用高背輪椅

25. Surgery Intervention
• Musculocutaneous flap: most common and most often
recommended in severe pressure ulcers in SCI.
– Skin transferred with underlying muscle/blood vessels
• Rotation flap:
– Semicircular flap rotating about a pivot point to close a
triangular defect
• Transposition flap:
– Rectangular flap rotates about its base to fill an adjacent
defect
• Advancement flap:
– Moved into a defect without lateral or rotational
movement

26. Postop Management for
Musculocutaneous Flap Procedures
• Strict bed rest—at least 3–4 weeks
• Vigilant pressure relief and avoidance of shear
forces
• Air-fluidized bed
– Temperature adjustable, good pressure relief,
absorption of wound fluids away, bacteriostatic
capabilities of the beads
• Sitting time: if no problem after immobilization
– Slowly increased: start 15 minutes daily and increase
by 15 minutes BID.
– Monitor flap closely afterwards.

27. • 下列有關壓瘡 (pressure ulcer) 的預防與治
療之敘述，何者最為正確？(93-1-72)
1.女性比男性容易得到壓瘡
2.體重越重者，得到壓瘡機會越大
3.睡氣墊床可以減輕局部壓力，不必翻身
4.壓瘡是局部微血管受壓、組織缺氧所造成
的

28. • 下列有關女性頸髓完全損傷患者的敘述，
何者錯誤？(100-1-57)
1.排卵與受孕能力正常
2.可以進行陰道性交
3.生產時可能發生自律神經異常反射
4.子宮收縮無力，需剖腹生產

29. Female Infertility After SCI
• Immediately following SCI, amenorrhea occurs in
85% of women with cervical and high thoracic
injuries and 50–60% of women overall.
• However, 50 and 90% (respectively) have return
of menstruation within 6–12 months after injury.
• SCI does not affect female fertility once menses
return.

30. Pregnancy
• The likelihood of pregnancy after spinal cord
injury is unchanged, since fertility is
unimpaired.
• Pregnant women with SCI may develop:
– Pressure ulcers
– Recurrent UTIs
– Increased spasticity
– Decreased pulmonary function

31. – Autonomic dysreflexia: may be the only clinical
manifestation of labor
– Uterine innervation arises from T10–T12 level. Patients
with lesions above T10 may not be able to perceive
uterine contractions.
• Treatment of choice is epidural anesthesia
• Epidural should continue at least 12 hours after the delivery or
until the dysreflexia resolves
• Need to distinguish from preeclampsia
– Slightly increased incidence of preterm labor
– Constipation
– Thromboembolism
– Leg edema

32. • 有關頸部脊髓損傷女性病人的功能的敘述
，下列何者錯誤？(92-1-95)
1.排卵功能正常
2.可以自然生產
3.產前陣痛正常
4.可以進行一般陰道性交

33. • 下列何者不是脊髓損傷直接造成的男性性
功能障礙？(97-2-54)
1.性慾低落
2.勃起困難
3.射精困難
4.沒有性高潮

34. SEXUAL DYSFUNCTION AFTER SCI
Male Sexual Act
•Male erectile and ejaculatory functions are complex
physiologic activities that require interaction between
vascular, nervous, and endocrine systems.
•Erections are controlled by parasympathetic nervous
system.
•Ejaculations are controlled by sympathetic nervous
system.

35. Male Infertility After SCI
• Fertility in men after SCI is impaired. As mentioned above,
two major causes are ejaculatory dysfunction and poor
semen quality.
• Poor semen quality is secondary to:
– Stasis of prostatic fluid
– Testicular hyperthermia
– Recurrent UTIs
– Abnormal testicular histology
– Changes in hypothalamic-pituitary-testicular axis
– Possible sperm antibodies
– Type of bladder management
– Long-term use of various medications