痉挛型脑性瘫痪患儿下肢H反射量化痉挛的初步研究  

The quantitative study of H reflex evaluating spasticity of positive lower limbs in spastic cerebral palsy children

作　　者：杨丽英[1] 高宝勤[1] 李萍[2] 刘洋[2] 

机构地区：[1]首都医科大学附属北京天坛医院儿科,100050 [2]北京神经外科研究所神经电生理科,100050

出　　处：《国际儿科学杂志》2009年第4期340-341,344,共3页International Journal of Pediatrics

摘　　要：目的研究痉挛型脑性瘫痪（脑瘫）患儿H反射变化及其评价肢体痉挛的可靠性，探求痉挛性高肌张力定量评估客观指标。方法选取临床确诊的20例脑瘫患儿及20例健康小儿作为对照组，均给予胫神经H反射检测和改良的综合痉挛量表（CSS）评分，分析二者的相关性。结果脑瘫患儿H反射潜伏期平均（19．38±3．15）腿，H波幅平均（3．90±3．15）μV，H／M波百分比34．86±17．80，下肢CSS评分平均7．75±2．27；对照组H反射潜伏期平均（21．15±2．（15）ms，H波幅平均（2．50±1．46）μV,H／M波百分比13．68±7．14。脑瘫患儿的H波潜伏期缩短，H波幅增大，H／M波百分比增高；脑瘫患儿的CSS评分和H波幅呈正相关，相关系数n=0．554，相关分析用双侧Pearson检验：P1=0．011，CSS评分和H／M波百分比显著正相关，相关系数r2=0．893，P2〈0．001，且CSS评分和H／M波百分比的线性方程为：y=-29．314＋8．384x。结论脑瘫患儿H反射活跃，潜伏期缩短、波幅增高，H波幅、H／M波百分比同CSS评价均呈线性相关，而H／M波百分比同CSS评价的线性相关更好，可作为脑瘫患儿痉挛下运动神经元兴奋性的量化指标。Objective To study the changes of H reflex and its dependability to estimate spasticity of lower limbs in spastic cerebral palsy children. Methods Twenty healthy children as control group and 20 spastic cerebral palsy children with spastic lower limbs in various degree as cerebral palsy group. They were all accepted H reflex examination of electromyogrophy in both lower limhs and CSS evaluation. We analyzed the relationship between the changes of H reflex latency and CSS scores.Results In cerebral palsy group,the average H reflex latency was （19.38 ±3.15 ）ins. The average H reflex amplitude was （3.90± 3.15）μV and the average H/M was 34.86± 17.80. In control group, the average H reflex latency was （ 21.15 ± 2.05 ） ms, the average H reflex amplitude was （2.5 ± 1.46 ） μV, the average H/M was 13.68 ± 7.14. The latency of H reflex in cerebral palsy group was shorter than that in control group. H reflex amplitude and H/M in cerebral palsy group was higher than that in control group. Both H reflex amplitude and H/M to CSS score of cerebral palsy group were positive with correlation of r l = 0.554（ P, = 0.011） and r2 = 0.893 （P2 〈 0.001）,H/M was more relied with CSS score than H reflex amplitude.Its linear regression formula was y= -29.314＋ 8.384x. Conclusion H reflex of legs in spastic cerebral palsy children was more active than that in contol group. H/M was a good marker to evaluate excitability of spinal neurons.

关 键 词：H反射 脑性瘫痪 肌电描记术 

分 类 号：R742.3[医药卫生—神经病学与精神病学] R247.4[医药卫生—临床医学]