床旁肌电图检查在危重神经肌肉疾病诊断中的价值  

Clinical utility of bedside electromyography in critical iH with suspected neuromuscular diseases

作　　者：刘明生[1] 崔丽英[1] 冯新红[1] 管宇宙[1] 李毅[1] 周祥[1] 胡晓芸[1] 

机构地区：[1]中国医学科学院北京协和医院神经内科,100730

出　　处：《中华神经科杂志》2012年第9期674-677,共4页Chinese Journal of Neurology

摘　　要：目的探讨危重症患者床旁肌电图检查的特点及其应用价值。方法收集肢体无力伴呼吸困难而疑诊神经肌肉病的危重患者，采用便携式肌电图仪进行床旁检查。测定项目包括节段性运动神经传导测定、感觉神经传导测定、F波、同芯针电极肌电图以及重复神经电刺激测定。对床旁肌电图测定结果结合临床进行分析。结果共对34例危重患者进行了床旁肌电图检查。其中5例肌电图检查正常；低频重复电刺激测定8例，其中4例出现复合肌肉动作电位波幅递减现象。节段性运动神经传导测定73．3％（22／30）的患者仅有复合肌肉动作电位波幅下降，20．0％（6／30）的患者证实存在脱髓鞘改变。55．0％（11／20）的患者无F波出现；28．6％（6／21）的患者感觉神经动作电位波幅下降；57．7％（15／26）的患者同芯针电极肌电图有异常自发电位。82．4％（28／34）的患者通过床旁肌电图检查能协助明确或排除诊断、指导处理方案的选择。11．8％（4／34）的患者通过床旁肌电图检查确认了周围神经病的存在，但对临床处理无影响。床旁肌电图检查在2例患者中未显示明确价值。结论床旁肌电图检查对于疑诊神经肌肉病的危重患者具有重要的诊断价值。检测手段中运动神经传导测定和重复神经电刺激最为关键；检查时应根据临床问题制订个体化检测方案，以最少的检查获得最有价值的信息。Objective To investigate the utility of bedside electromyography （EMG） in diagnosis and management of critical illness patients with suspected neuromuscular diseases. Methods Bedside EMG was performed in 34 critical illness patients with weakness and respiratory involvement, including segmental motor nerve conduction studies, sensory nerve conduction studies, F waves, concentric needle EMG and repetitive nerve stimulation. The clinical manifestations and clinical utility of bedside EMG in critical illness patients with suspected neuromuscular diseases were analyzed. Results EMG was normal in 5 patients. Low-frequency repetitive nerve stimulation showed decrement response of compound muscle action potential （CMAP） in 4 of 8 patients. Motor nerve conduction studies showed CMAP amplitude decreased in 73.3% （22/30） patients, and demyelinating changes was detected in 20. 0% （6/30） patients. F-wave persistence was 0 in 55.0% （ 11/20）patients. Amplitude of sensory nerve action potential decreased in 28.6% （6/21） patients. Bedside EMG could help to confirm or exclude diagnoses and guide the management in 82.4% （28/34） patients, confirm the diagnoses of peripheral neuropathy but have no effect on management in 11.8% （4/34） patients, and bedside EMG was inconclusive in 2 patients. Conclusions Bedside EMG is useful for the diagnosis and management of critical ill with suspected neuromuscular diseases, while motor nerve conduction studies and repetitive nerve stimulation are more valuable. Individualized protocol for EMG studies should be made on the basis of clinical problem.

关 键 词：危重病 神经肌肉疾病 肌电描记术 

分 类 号：R746[医药卫生—神经病学与精神病学]