一氧化二氮滥用所致周围神经病的神经电生理特点  

Neurophysiological characteristics of nitrous oxide-induced neuropathy

作　　者：董明睿[1] 王丽[1] 孙青[1] 孙少杰[1] 郝慧 严莉[1] 段晓慧[1] 王云云 焦劲松[1] 刘尊敬[1] 彭丹涛[1] 汪仁斌[1] DONG Mingrui;WANG Li;SUN Qing;SUN Shaojie;HAO Hui;YAN Li;DUAN Xiaohui;WANG Yunyun;JIAO Jinsong;LIU Zunjing;PENG Dantao;WANG Renbin(Department of Neurology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院神经科,100029 [2]中日友好医院保健部二部,100029

出　　处：《中国神经免疫学和神经病学杂志》2019年第2期116-120,125,共6页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨一氧化二氮(N_2O;俗称"笑气")滥用导致的中毒性周围神经病的神经电生理特点。方法回顾性分析2015-07—2018-03期间中日友好医院神经科就诊的15例N_2O滥用导致的周围神经病患者的临床表现,实验室检查,头、颈、胸椎MRI及神经传导检查情况。对照组44例(肢带型肌营养不良23例、脂质沉积病5例、低钾性周期性麻痹8例、视神经脊髓炎8例)行神经传导检查,所检神经的神经传导速度和动作电位波幅均在正常范围,并排除周围神经病变。其中作为正中神经对照23例(29条)、尺神经对照20例(22条)、腓神经对照25例(25条)、胫神经对照25例(32条)。结果 15例患者均临床表现为肢体无力和麻木,下肢肌力下降及感觉损害程度均较上肢为著。其中8例患者MRI显示颈段或颈胸段脊髓后索倒"V"型长T2病灶。与对照组比较,病变组正中神经、尺神经、腓神经、胫神经运动传导速度(MCV)平均值分别下降14.1%、11.1%、18.3%、21.5%;远端复合肌肉动作电位(CMAP)波幅分别下降29.6%、19.5%、63.6%、82.5%(均P<0.05);与对照组比较,病变组上、下肢感觉传导速度(SCV)减慢、下肢感觉神经动作电位(SNAP)波幅下降(均P<0.05)。7条腓神经和3条胫神经复合肌肉动作电位波幅未测出。2例患者存在运动神经传导阻滞。结论 N_2O滥用可导致神经系统损害,以颈胸段脊髓后索病变和周围神经病变多见。周围神经损害可同时累及运动纤维及感觉纤维,包括轴索变性和脱髓鞘,下肢损害程度较上肢为著。运动轴索较感觉轴索更易受损。受累神经可出现运动传导阻滞。Objective To investigate the neurophysiological characteristics of nitrous oxide-induced neuropathy. Methods Clinical manifestation, laboratory examinations, cervical-thoracic vertebra MRI and nerve conduction studies of 15 patients with nitrous oxide(N 2O)-induced neuropathy were retrospectively collected from Department of Neurology, China-Japan Friendship Hospital from July 2015 to March 2018.In the control group, 44 patients (including 23 cases of limb-girdle muscular dystrophy, 5 cases of lipid storagemyopathy, 8 cases of hypokalemic periodic paralysis and 8 cases of neuromyelitis optica) underwent nerve conduction examination. The nerve conduction velocity and action potential amplitude were in the normal range and peripheral neuropathy was excluded in the control group. Nerve conduction studies were done in 29 median nerves, 22 ulnar nerves, 25 peroneal nerves and 32 tibial nerves which were normal for control. Results 15 patients manifested as weakness and numbness in four limbs;motor and sensory impairments were more severe in lower limbs than upper limbs. T2-weighted MRI scans showed hyperintensity lesions shaped inverted 'V'-sign at the posterior column of the spinalcad from the second cervical to thoracic vertebrae level in 8 patients. Compared with the control group, the mean motor conduction velocity (MCV) of the median nerve, ulnar nerve, peroneal nerve and tibial nerve decreased by 14.1%, 11.1%, 18.3% and 21.5% respectively, and the amplitude of distal compound muscle action potential (CMAP) decreased by 29.6%, 19.5%, 63.6% and 82.5%, respectively, all with significant difference (all P < 0.05). Compared with the control group, the sensory conduction velocity (SCV) of upper and lower limbs and the amplitude of sensory nerve action potential (SNAP) of lower limbs in the lesion group decreased significantly (all P < 0.05). CMAP were not detected in 7 peroneal nerve and 3 tibial nerve. Motor nerve conduction block were detected in 2 patients. Conclusions Neurological impairment induced by N 2O abuse

关 键 词：一氧化二氮 周围神经病 神经传导 

分 类 号：R745[医药卫生—神经病学与精神病学]