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王 培,付娟娟,周 停,张文通,苏彩霞,沈 滢,鲁 俊,周秋敏,任 习,孟 婷,许光旭,王红星.脑卒中患者周围神经与肌肉神经电生理特征分析[J].中国康复医学杂志,2018,(5):545~550
脑卒中患者周围神经与肌肉神经电生理特征分析    点此下载全文
王 培  付娟娟  周 停  张文通  苏彩霞  沈 滢  鲁 俊  周秋敏  任 习  孟 婷  许光旭  王红星
南京医科大学康复医学院,南京,210029
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DOI:
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摘要:
      摘要 目的:通过神经传导及同心圆针肌电图检测探讨脑卒中患者周围神经、肌肉的神经电生理变化特征,为脑卒中后神经肌肉功能评估和预后判断提供依据。 方法:对符合入选标准的41例脑卒中患者进行双侧正中、尺、桡、肌皮、腋、肩胛上、胫、腓神经运动传导及双正中、尺、桡、胫、腓神经感觉传导检测,双拇短展肌、伸指总肌、肱二头肌、三角肌、冈上肌、胫前肌、比目鱼肌行同心圆针肌电图检测。采用Brunnstrom分期评价肢体功能。分析健、患侧肢体神经及肌肉的神经电生理指标差异及其与肢体功能的相关性。 结果:①运动神经传导:与健侧比较,偏瘫侧正中、尺、桡、腋、肩胛上、胫、腓神经复合肌肉动作电位(compound muscle action potential,CMAP)波幅均显著降低(P<0.05),腓总神经末端潜伏期延长及腓骨小头-踝传导速度减慢(P<0.05),其他各神经末端潜伏期均无明显差异;病程3—6个月患者正中、尺、桡神经运动传导异常率均高于其他病程组;②感觉神经传导:偏瘫侧桡、腓浅神经SNAP波幅较健侧降低,尺、桡神经传导速度较健侧减慢(P<0.05),且有9例患者健侧正中神经感觉传导速度减慢;病程3—6个月患者正中神经和腓浅神经感觉传导异常率高于其他病程组;③同心圆针肌电图:不同病程均有一定比例脑卒中患者上下肢肌肉可见纤颤电位、正锐波等异常自发电位;肢体远端肌肉,如拇短展肌、伸指总肌在各个病程中出现自发电位的比例均较高;病程6个月以上者,三角肌的自发电位发生率增高,而比目鱼肌在各个病程的患者中自发电位的出现率均较高;无主动收缩功能肌肉自发电位出现率显著高于有主动收缩功能肌肉(P=0.000);④患者手Brunnstrom分期与尺神经偏瘫侧/健侧CMAP波幅比呈正相关(r=0.426,P<0.05)。 结论:脑卒中患者偏瘫侧运动神经轴索变性及脱髓鞘伴部分感觉神经脱髓鞘和轴索变性,且以病程3—6个月患者最为多见;同时手功能Brunnstrom分期与尺神经运动传导CMAP波幅具有相关性;偏瘫侧肢体肌肉失神经支配改变以肢体远端肌肉和无主动收缩功能肌肉为主。
关键词:脑卒中  神经传导  同心圆针肌电图  神经肌肉功能
Electrophysiological changes of peripheral nerves and muscles in patients with stroke    Download Fulltext
School of Rehabilitation Medicine of Nanjing Medical University, Nanjing, 210029
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Abstract:
      Abstract Objective: To investigate the electrophysiological changes of peripheral nerves and muscles in patients with stroke. Method: Standard motor nerve conduction examination was performed in bilateral median, ulnar, radial, musculocutaneous, axillary, suprascapular, tibial and peroneal nerves. Sensory nerve conduction examination was performed in bilateral median, ulnar, radial, peroneal and sural nerves. Concentric needle electromyography (nEMG) was tested in bilateral abductor pollicis brevis, extensor digitorum communis, biceps brachii, deltoid, supraspinatus, tibial anterior and soleus muscles. The motor function of affected upper extremity was assessed by Brunnstrom grade. Then the changes in electrophysiological outcomes of both sides were compared and the correlation between Brunnstrom scale and the value of compound muscle action potential(CMAP) amplitude in affected upper extremities were analyzed. Result: ① Characteristics of motor nerve conduction: compared with the contralateral, CMAP amplitudes of median, ulnar, radial, axillary, suprascapular, tibial and peroneal nerves decreased significantly (P<0.05), and the conduction velocity of peroneal nerve was slower (P<0.05). But there was no significant difference between distal motor latency of both sides, except for peroneal nerve. The rate of abnormal conduction of median, ulnar and radial nerves was higher in patients with a period of 3 to 6 months than other periods. ② Characteristics of sensory nerve conduction: there were no significant differences between both sides, except decreased SNAP amplitude found in the radial, peroneal nerves and lower nerve conductive velocity found in the ulnar and radial nerves (P<0.05). Further, lower velocity of median sensory nerve conduction on unaffected side was found in nine patients with a longer period of more than 6 months. The rate of abnormal conduction of median, peroneal nerves was higher in patients with a period of 3 to 6 months than other periods. ③ nEMG: Spontaneous activities (SA), including fibrillations and positive sharp waves, were noted in all affected muscles examined. Higher rate of SA was found in the distal muscles, such as abductor pollicisbrevis, extensor digitorumcommunis. Deltoid muscle has high rate SA in patients above 6 months period and high rate SA was also found in soleus muscles in all patients with different periods. In affected side, muscles without voluntary contraction have higher SA than those can contract (P=0.000). ④ The Brunnstrom grade was correlated positively with the affected/unaffected CMAP ratio of ulnar nerve (r=0.426, P<0.05). Conclusion: Axonal motor neuropathy with demyelination and partial sensory nerve demyelination of affected side were the main electrophysiological characteristics in patients with stroke, especially for patients with a period of 3 to 6 months. And hand motor function was correlated with the CMAP amplitude of ulnar nerve. Muscle denervation was found seriously in distal muscles and paralyzed muscles without voluntary contraction.
Keywords:stroke  nerve conduction  needle electromyography  neuromuscular function
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