声带运动不良的喉肌电图特征  

Laryngeal electromyographic characteristics of vocal fold immobility

作　　者：徐文[1] 韩德民[1] 侯丽珍[1] 张丽[1] 赵功伟[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2006年第9期653-656,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨声带运动不良的喉肌电及诱发肌电变化特征。方法对108例声带活动不良患者临床表现、喉肌电图(自发电位、运动单位电位及募集电位等)及神经诱发电位特征(潜伏期、时程、波幅)进行分析。结果喉返神经麻痹者患侧甲杓肌、环杓后肌可检测到失神经电位如纤颤波和正锐波及再生电位。完全麻痹者肌电为电静息,相应喉内肌诱发电位消失。神经不完全损伤者患侧相应喉肌正常运动单位电位中夹杂失神经电位或再生电位,募集电位为单纯相或混合相,神经诱发电位较弱,其中患侧甲杓肌(2.2±1.0)ms(±s,以下同)、环杓后肌(2.4±1.0)ms 诱发电位平均潜伏期均大于正常受试者(P<0.05);诱发电位波幅离散程度较大,患侧甲杓肌(0.9±0.7)mV、环杓后肌(1.2±1.0)mV 平均诱发电位波幅均明显小于正常受试者(P<0.05)。环杓关节运动障碍者喉肌电正常或稍活跃,神经诱发电位参数与正常无统计学差异。肿瘤侵犯喉肌患者肌电减弱,神经诱发电位潜伏期正常,波幅减小。结论声带活动不良可以通过常规喉肌电图进行初步定性筛查,后经喉神经诱发电位进一步进行半定量分析。Objective To investigate the characteristics of laryngeal electromyography and evoked electromyography in vocal fold immobility. Methods 108 cases of vocal fold immobility were analyzed by clinical manifestation and laryngeal electromyography characteristics, including spontaneous potential activity, motor unit potential （ MUP ） measurement, recruitment pattern analysis and evoked electromyography evaluation. Results Neurogenic vocal fold immobility showed a wide variety of abnormal activity. Fibrillation potentials and positive sharp waves were found in patients with laryngeal nerve injuries. For laryngeal paralysis, there was no reaction with LEMG and evoked LEMG. For laryngeal paresis, it showed decreased MUP and decreased recruitment activities with simple pattern recruitment or mixed pattern recruitment, and decreased evoked muscle response potentials were also shown with delayed latency than normal （P 〈0.05） in the TA （2. 2 ±1.0） ms（x^-±s） , PCA （2.4 ± 1.0） ms and lower amplitude in the TA （0. 9 ±0.7） mV and PCA （1.2 ± 1.0） mV （P 〈 0. 05 ）. Patients with vocal fold mechanical limitations generally yielded normal LEMG and Evoked LEMG. Patients with neoplastic infiltration of the laryngeal muscles demonstrated decreased LEMG and nearly normal Evoked LEMG with normal latency and lower amplitude. Conclusions General EMG and evoked EMG play a crucial role in the diagnosis of vocal fold immobility.

关 键 词：喉疾病 喉肌 肌电描记术 喉神经 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]