次課內(nèi)臟神經(jīng)和脊髓

TheVisceralNerve

內(nèi)臟神經(jīng)神經(jīng)系統(tǒng)（二）浙江大學(xué)醫(yī)學(xué)部趙經(jīng)緯教授神經(jīng)科學(xué)研究所PI

2014年12月23日人體形態(tài)學(xué)基礎(chǔ)實(shí)驗(yàn)－第9次課內(nèi)臟神經(jīng)

內(nèi)臟神經(jīng)分布于內(nèi)臟、心血管、腺體等，包括：

內(nèi)臟運(yùn)動(dòng)神經(jīng)又叫自主神經(jīng)或植物性神經(jīng)，支配心肌、平滑肌、腺體，不受意志控制。分為互相拮抗的交感神經(jīng)和副交感神經(jīng)。

內(nèi)臟感覺(jué)神經(jīng)分布到內(nèi)臟黏膜、心血管內(nèi)膜、腺體等處。

PlaceofthePNSinthestructuralorganizationofthenervoussystemCNSSensorydivisionMotordivisionAutonomicnervoussystemSympatheticdivisionParasympatheticdivisionPNSSomaticnervoussystem一、內(nèi)臟運(yùn)動(dòng)神經(jīng)

內(nèi)臟運(yùn)動(dòng)神經(jīng)與軀體運(yùn)動(dòng)神經(jīng)區(qū)別：

序號(hào)軀體運(yùn)動(dòng)神經(jīng)內(nèi)臟運(yùn)動(dòng)神經(jīng)

1直接支配——骨骼肌，支配——心肌、平滑肌、腺體，

2隨意支配不隨意支配

3低級(jí)中樞位于腦干（軀體運(yùn)動(dòng)低級(jí)中樞位于腦干（內(nèi)臟運(yùn)動(dòng)核）

核）或脊髓（前角運(yùn)動(dòng)細(xì)胞）

或脊髓T1-L3側(cè)角和S2-4骶副交感

核，

4一個(gè)神經(jīng)元二個(gè)神經(jīng)元，換元，分節(jié)前纖維和

節(jié)后纖維

5不分類分為交感神經(jīng)和副交感神經(jīng)Maindifferencesbetweensomaticmotorandvisceralmotorn.軀體運(yùn)動(dòng)神經(jīng)與內(nèi)臟運(yùn)動(dòng)神經(jīng)之區(qū)別SomaticVisceralEffectorsSkeletalmusclesCardiac,smoothmusclesandglandsFromlowercentertoeffectrequireSingleneuronTwoneurons:preganglionicneuron(fiber)andpostganglionicneuron(fiber)KindoffibersOneTwo:sympatheticandparasympatheticFibersThickmyelinatedPreganglionic:thinmyelinatedPostganglionic:unmyelinatedDistributiveformNervetrunkNerveplexusesControlVoluntary(consciousness)Involuntary(unconsciousness)Comparisionofthesomaticandautonomicnervoussystem軀體運(yùn)動(dòng)神經(jīng)與內(nèi)臟運(yùn)動(dòng)神經(jīng)之比較（一）交感神經(jīng)

1.低級(jí)中樞部：

脊髓T1-L3側(cè)角

2.交感神經(jīng)節(jié)：

椎旁節(jié)（交感干）

位于脊柱兩側(cè)，

有19—24對(duì),分為：

頸節(jié)(3對(duì)）、

胸節(jié)（10-12對(duì)）、

腰節(jié)（4-5對(duì)）、

骶節(jié)（4-5對(duì)）、尾節(jié)（1個(gè)，奇節(jié)）

椎前節(jié)：位于脊柱前方，同名血管周圍。

3.神經(jīng)：

灰交通支、白交通支、

內(nèi)臟大神經(jīng)、內(nèi)臟小神經(jīng)、

腰內(nèi)臟神經(jīng)

（一）交感神經(jīng)sympatheticnerve

1.低級(jí)中樞部：

脊髓T1-L3側(cè)角的中間外側(cè)核。

交感神經(jīng)節(jié)

（1）椎旁節(jié)——位于脊柱兩側(cè)，有19—24對(duì)。

節(jié)間支+椎旁神經(jīng)節(jié)=交感干

（2）椎前節(jié)——位于脊柱前方，有成對(duì)的腹腔神經(jīng)節(jié)、成單的腸系膜上神經(jīng)節(jié)、腸系膜下神經(jīng)節(jié)，位于同名血管周圍?；?、白交通支

白交通支：由脊神經(jīng)進(jìn)入椎旁神經(jīng)節(jié)的節(jié)前纖維灰交通支：由椎旁神經(jīng)節(jié)返回脊神經(jīng)的節(jié)后纖維Sympathetictrunks

Lowercenter:inlateralhornofT1~L3(orC8~L3)segmentsofspinalcord(intermediolateralnucleus)

Peripheralpart:sympathetictrunks交感干

sympatheticganglia交感神經(jīng)節(jié)

sympatheticplexuses交感神經(jīng)叢

sympatheticnerves交感神經(jīng)

communicatingbranches節(jié)間支SympatheticNerveSystem交感神經(jīng)系統(tǒng)Peripheralpart:周圍部1.sympathetictrunksparavertebralgangliaImunicatingbranchesgrayramuswhiteramusSympathetictrunk交感干FormedbyparavertebralgangliaandinterganglionicbranchesLieoneithersideofvertebralcolumnfrombaseofskulltococcyxThetrunksoftwosideuniteinfrontofthecoccyxatasmallswelling,theganglionimpar(奇節(jié)）Paravertebralganglia交感神經(jīng)節(jié)ArrangedoneithersideofvertebralcolumnConsistof19~22ofoval-shapedgangliacervicalganglion3

thoracicganglion10~12

lumbarganglion4~5

sacralganglion2~3coccygeal

ganglion1

CervicalganglionThoracicganglionPrevertebralganglia椎前節(jié)LieanteriortovertebralcolumnandnearthearteriesforwhichtheyarenamedCeliacganglion

腹腔神經(jīng)節(jié)Aorticorenalganglion

主動(dòng)脈腎節(jié)Superiormesentericganglion

腸系膜上神經(jīng)節(jié)Inferiormesentericganglion

腸系膜下神經(jīng)節(jié)123交感干sympathetictrunk：節(jié)前纖維有三種去向：

（1）終止于相應(yīng)椎旁節(jié)；（2）在交感干內(nèi)上行或下行一段→椎旁節(jié)

（3）穿椎旁節(jié)→椎前節(jié)

節(jié)后纖維有3種去向：

（1）經(jīng)灰交通支返回到脊神經(jīng)。（2）隨動(dòng)脈走行，在動(dòng)脈周圍形成神經(jīng)叢。

（3）節(jié)后纖維直接到臟器。Preganglionicfibers15pairswhitecommunicatingbranchSympathetictrunk

(onlyspinallevelsT1~L3havewhitecommunicatingbranch)Threefatesofpreganglionicfibers

節(jié)前纖維的三種去向

ThreefatesofpreganglionicfibersRelayincorrespondingganglionAscendordescendinsympathetictrunkandrelayinhigherorlowergangliaPasswithoutsynapsetoaprevertebralganglionforrelayGreatersplanchnicnerve

內(nèi)臟大神經(jīng)

formedbypreganglionicfibersfromT5~T9ganglia,andrelayinceliacganglion.Lessersplanchnicnerve

內(nèi)臟小神經(jīng)

formedbypreganglionicfibersfromT10~T12ganglia,andrelayinaorticorenalganglion.Thepostganglionicfiberssupplytheliver,spleen,kidneyandalimentarytractasfarastheleftcolicflexure.Lumbarsplanchnicnerve腰內(nèi)臟神經(jīng)FormedbypreganglionicfibersfromL1~L4ganglia,andrelayinprevertebralganglia(Inferiormesentericganglion腸系膜下節(jié)).Thepostganglionicfiberssupplydescendingandsigmoidcolon,rectum,pelvicvisceraandlowerlimbs.Backtoaspinalnervealonggraycommunicatingbranches灰交通支

(31pairs)toterminateinbloodvessels,arrectorespilorumandsweatglandsofhead,neck,trunkandlimbsThefibersfromtheirnetworksaroundbloodvesselspassingtovisceralendorgansTerminatedirectlyincertainorgansThreefatesofpostganglionicfibers

節(jié)后纖維的三種去向Distributionofsympatheticnerve

交感神經(jīng)的分布Preganglionicfibers節(jié)前纖維Postganglionicfibers節(jié)后纖維T1~T5Head,neck,upperlimbandthoracicvisceraT5~T12AbdominalvisceraL1~L3Pelvicvisceraandlowerlimb（二）副交感神經(jīng)

1.低級(jí)中樞：

腦干的副交感核

骶髓（S2-4）

2.副交感神經(jīng)節(jié)

器官旁和

器官內(nèi)神經(jīng)節(jié)。

3.副交感神經(jīng)：

III.,VII.,IX.,X對(duì)

腦神經(jīng)；

盆內(nèi)臟神經(jīng)。ParasympatheticNerveSystem副交感神經(jīng)系統(tǒng)Parasympatheticnerve副交感神經(jīng)Lowercenter:

locatedinfourpairsparasympatheticnucleiinbrainstemandinsacralparasympatheticnucleusofspinalcordsegmentsS2~S4Parasympatheticganglia:

terminalgangliaarenearorwithinthewallofavisceralorgan

Para-organganglia器官旁節(jié)：Ciliaryganglion睫狀神經(jīng)節(jié)Pterygopalatineganglion翼腭神經(jīng)節(jié)Submandibularganglion下頜下神經(jīng)節(jié)

Oticganglion

耳神經(jīng)節(jié)Intramuralganglia壁內(nèi)節(jié)

Cranialportion顱部Ⅲciliaryganglion睫狀神經(jīng)節(jié)sphincterpupillaeandciliarymuscles瞳孔括約肌和睫狀肌pterygopalatineganglion蝶腭神經(jīng)節(jié)Ⅶlacrimalgland淚腺submandibularganglion下頜下神經(jīng)節(jié)sublingualglandsubmandibulargland舌下腺和下頜下腺Ⅸoticganglion耳神經(jīng)節(jié)parotidgland腮腺Ⅹterminalganglia終節(jié)heart,lungs,liver,spleenkidneys,alimentarytractas

faras

leftcolicflexure

Sacralportion骶部

PreganglionicfibersfromsacralparasympatheticnucleusleavespinalcordwithanteriorrootsofthespinalnervesS2~S4,ThenleavesacralnervesandformpelvicsplanchnicnerveandtravelbywayofpelvicplexustoterminalgangliainpelviccavityPostganglionicfibersterminateindescendingandsigmoidcolon,rectumandpelvicviscera（三）交感神經(jīng)和副交感神經(jīng)的比較1.低級(jí)中樞不同：交感：脊髓的胸腰段側(cè)角副交感：腦干和脊髓的骶2-4節(jié)的副交感核2.神經(jīng)節(jié)不同：交感：椎旁節(jié)和椎前節(jié)副交感：器官旁和器官內(nèi)節(jié)3.節(jié)前、節(jié)后纖維的長(zhǎng)度不同：交感：節(jié)前纖維短，節(jié)后纖維長(zhǎng)副交感：節(jié)前纖維長(zhǎng)，節(jié)后纖維短4.分布范圍不同：交感分布比副交感廣5.作用互相拮抗Maindifferencesbetweensympatheticandparasympathetic

交感與副交感神經(jīng)之區(qū)別Sympathetic交感神經(jīng)Parasympathetic副交感神經(jīng)LowercenterLateralgrayhornofspinalcordsegmentsT1~L3FourpairsparasympatheticnucleiandsacralparasympatheticnucleusGangliaParavertebral,椎旁節(jié)prevertebral椎前節(jié)Terminal終節(jié)Preganglionicf.ShorterLongerPostganglionicf.LongerShorterPre:Postganglionic1:manymore1:afewDistributionsThroughoutthebodyLimitedprimarilytoheadandvisceraofthorax,abdomen,andpelvisDifferentactionPreparesforemergencysituation(fightorflight)Conserveandrestorebodyenergy(restandrelaxation)交感強(qiáng)心縮血管氣管擴(kuò)張瞪大眼抑制胃腸膀胱緩應(yīng)激豎毛又出汗交感神經(jīng)系統(tǒng)的作用Visceralsensorynerves內(nèi)臟感覺(jué)神經(jīng)EnteroceptorsⅦ，Ⅸ,Ⅹ

Nucleusofsolitarytract孤束核SympatheticnervePelvicsplanchnicnerve交感和副交感神經(jīng)Posteriorhorn后角Thalamus丘腦Hypothalamus下丘腦Cerebralcortex大腦皮質(zhì)SomaticmotorneuronsvisceralmotorneucleiEffectors

二、內(nèi)臟感覺(jué)神經(jīng)

接受內(nèi)臟器官的黏膜、心血管的內(nèi)膜、腺體等處的內(nèi)感覺(jué)。

第1級(jí)神經(jīng)元位于脊神經(jīng)節(jié)，腦干內(nèi)為孤束核。內(nèi)臟感覺(jué)的定位不確切，有牽涉痛Referredpain牽涉痛

ReferredpainHeartLungsanddiaphragmLiverGallbladderStomachKidneysOvariesSmallintestineUretersUrinarybladderColonPancreasLiverHeartAppendixGallbladder思考題內(nèi)臟運(yùn)動(dòng)神經(jīng)與軀體運(yùn)動(dòng)神經(jīng)在形態(tài)結(jié)構(gòu)上有何不同？交感神經(jīng)和副交感神經(jīng)在形態(tài)結(jié)構(gòu)上有何區(qū)別？解釋：節(jié)前神經(jīng)元、節(jié)后神經(jīng)元、節(jié)前纖維、節(jié)后纖維指出下列神經(jīng)的性質(zhì)：內(nèi)臟大神經(jīng)、內(nèi)臟小神經(jīng)、腰內(nèi)臟神經(jīng)、盆內(nèi)臟神經(jīng)指出下列神經(jīng)節(jié)的性質(zhì)：睫狀神經(jīng)節(jié)、翼腭神經(jīng)節(jié)、下頜下神經(jīng)節(jié)、耳神經(jīng)節(jié)、三叉神經(jīng)節(jié)、腹腔神經(jīng)節(jié)、腸系膜上神經(jīng)節(jié)、腸系膜下神經(jīng)節(jié)、主動(dòng)脈腎節(jié)、脊神經(jīng)節(jié)CentralNervousSystemTheSpinalCord

脊髓位置（Location）:

枕骨大孔foramenmagnum→第一腰椎下緣thefirstlumbarvertebra8條溝（fissureorsulci):2個(gè)膨大（Enlargements):

頸膨大

cervical:C4-T1

腰骶膨大lumbosacral:L1-S3脊髓圓錐Conusmedullaris:終絲Filumterminale:31個(gè)節(jié)段（Segment):前正中裂、后正中溝

前外側(cè)溝：前根走出

后外側(cè)溝：后根進(jìn)入

（有脊神經(jīng)節(jié)）ExternallongitudinalfissureandsulcisulcusfissureFilumterminaleCaudaequinaanteriorlateralanteriormedianposteriorlateralsulcusposteriormediansulcus脊髓的節(jié)段性

31個(gè)節(jié)段：C——8T——12L——5S——5Coc——1

馬尾腰椎穿刺：腰3－4間

Correspondingrelationshipbetweenspinalsegmentsandvertebrae

spinalsegmentsvertebraebodies

C1-C4C1-C4C5~C8,Tl~T4C4~T3T5~T8 T3~T6T9-T12 T6-T9L1-L5 T10-T12Sl~S5,Co1LI

脊髓節(jié)段Spinalsegment

It'sapartofspinalcord,whichisconnectedwiththerootletsofapairofspinalnerve.

31segmentscervicalsegments8

thoracicsegments12

lumbarsegments5

sacralsegments5

coccygealsegments1

脊髓內(nèi)部結(jié)構(gòu)

1.centralcanal：

內(nèi)含腦脊液(CSF)

2.graymatter：

anteriorhorn前角：

軀體運(yùn)動(dòng)性

posteriorhorn后角：固有核、胸核等

感覺(jué)性

intermediatezone中間帶

lateralhorn：中間外側(cè)核

交感性，見(jiàn)于脊髓的T1—L3

骶2-4節(jié)的副交感核

副交感性，見(jiàn)于脊髓的S2-4

（RexedLaminae:10層）

intermediolateralnucleusIntermediomedialnucleus:thenucleusposteromarginalisthesubstantiagelatinosathenucleuspropriusthedorsalnucleus(thoracicnucleus)medialgrouplateralgroup

anteriorhorn前角:

medialgrouplateralgroup

intermediatezone中間帶:

intermediolateralnucleus中間外側(cè)核

intermediomedialnucleus中間內(nèi)側(cè)核

posteriorhorn后角:nucleusposteromarginalis邊緣核

substantialgelatinosa膠狀質(zhì)

nucleusproprius固有核

dorsalnucleus背核

(thoracicnucleus胸核)Thenucleiandthelaminas（板層）thenucleusposteromarginalisthesubstantiagelatinosathenucleuspropriusthedorsalnucleus(thoracicnucleus)intermediolateralnucleusIntermediomedialnucleus:medialgrouplateralgroup

Whitematter:3parts:anterior,lateralandposteriorfuniculus

posteriorfuniculuslateralfuniculusanteriorfuniculusanteriorwhitecommissureposteriorlateralsulcusposteriormediansulcusanteriorlateralsulcusanteriormedianfissurefuniculusproprius3.whitematter：

ant.lat.post.Funiculus⑴ascendingbundle

fasciculusgracilis(T4以下）

fasciculuscuneatus（T4以上）傳導(dǎo)精細(xì)觸覺(jué)和深感覺(jué)

spinothalamictract（傳導(dǎo)淺感覺(jué)）側(cè)束：傳導(dǎo)對(duì)側(cè)痛、溫覺(jué)前束：傳導(dǎo)對(duì)側(cè)粗觸覺(jué)和壓覺(jué)

ant.&post.spinocerebellartract

傳導(dǎo)反射性本體感覺(jué)（平衡）

⑵descendingbundlecorticospinaltract支配骨骼肌的隨意運(yùn)動(dòng)前束支配雙側(cè)軀干肌側(cè)束支配同側(cè)四肢肌

rubrospinaltract紅核脊髓束vestibulospinaltract前庭脊髓束tectospinaltract頂蓋脊髓束reticulospinaltract網(wǎng)狀脊髓束mediallongitudinalfasciculus內(nèi)側(cè)縱束⑶properfasciculus固有束⑷anteriorwhitecommissure白質(zhì)前連合

由脊髓丘腦前束和后束、皮質(zhì)脊髓前束、脊髓小腦前束等纖維左、右交叉而成。

脊髓內(nèi)部結(jié)構(gòu)lateralhornposteriorhorngraycommissureIntermediatezoneanterior

horncentralcanalGraymatter

GraymatterParts分部:Mainnuclei主要核團(tuán):Lateralhorn外側(cè)角

(onlyextendsfromTltoL3segments.)

graycommissure灰質(zhì)聯(lián)合

(anteriorandposterior)Maintracts(orfasciculi):

Ascendingtracts上行纖維束:fasciculusgracilis(薄束）:comefromsacral,lumbarandlowersixthoracicnerves,terminateuponnucleusgracilis

fasciculescuneatus（楔束）:comefromcervicalanduppersixthoracicnerves,terminateuponnucleuscuneatus.

*conductsthefinetactileandkinestheticsenseoftheipsilateraltrunkandlimbs.fasciculesgracilisfasciculescuneatusSpinothalamictracts（脊髓丘腦束）anteriorspinothalamictractslateralspinothalamictracts

---arisesfromoppositenucleusproprius---terminateonthalamus---c