急性大脑中动脉脑梗死患者的躯体感觉变化特征及其与神经功能损伤的关系  

Characteristics of somatosensory changes in patients with acute middle cerebral artery infarction and its relationship with neurological impairment

作　　者：张萍淑[1] 吕淑娟[1] 欧亚[1] 钱琳琳 乔思佳 元小冬[1] Zhang Pingshu;Lyu Shujuan;Ou Ya;Qian Linlin;Qiao Sijia;Yuan Xiaodong(Department of Neurology,Kailuan General Hospital&Neurobiology Key Laboratory of HeBei,Tangshan 063000,China)

机构地区：[1]开滦总医院神经内科河北省神经生物机能重点实验室,河北省唐山市063000

出　　处：《中国综合临床》2020年第3期240-244,共5页Clinical Medicine of China

基　　金：河北省医学适用技术跟踪项目(G201759)。

摘　　要：目的探讨急性大脑中动脉(middle cerebral artery,MCA)脑梗死患者双上肢躯体感觉诱发电位(somatosensory evoked potential,SEP)与神经功能损伤的关系。方法选择2015年1月至2016年12月在开滦总医院神经内科就诊的整体急性MCA供血区脑梗死患者共62例,进行回顾性前瞻性队列研究,其中男38例,女24例;年龄为(66.7±10.9)岁,年龄范围(33.0~85.0)岁。依据脑梗死侧别进行分组,其中左侧MCA脑梗死组37例,右侧MCA脑梗死组25例。入院48 h内应用肌电图诱发电位仪测定双上肢SEP,记录大脑皮质电位N20、P25、N35各波的峰潜伏期、波幅、电活动波形出现情况。结果左、右侧MCA脑梗死组,病灶对侧肢体SEP检测结果分别为正中神经正常1例(2.70%)、5例(20.00%),异常36例(97.30%)、20例(80.00%);两组间正中神经异常比率,差异有统计学意义(χ^2=12.577,P<0.001)。尺神经正常3例(8.11%)、4例(16.00%),异常34例(91.89%)、21例(84.00%);两组间尺神经异常比率,差异无统计学意义(χ^2=2.320,P=0.128)。左、右侧MCA脑梗死组SEP异常结果中各波峰潜伏期延长和/或波幅降低分别为正中神经34例(60.71%)、尺神经33例(60.00%),电活动波形消失分别为正中神经22例(39.29%)、尺神经22例(40.00%)。波峰潜伏期延长和/或波幅降低、电活动波形消失,正中神经和尺神经比较,差异无统计学意义(χ^2=0.021,P=0.885)。左、右侧MCA脑梗死组美国国立卫生院卒中量表(National Institue of Health Storke Scale,NIHSS)评分,中度及以上神经功能损伤分别为34例(91.89%)、19例(76.00%)。其中电活动波形消失分别为正中神经18例(52.94%)、4例(21.05%);尺神经18例(52.94%)、4例(21.05%)。中度及中度以上神经功能损伤患者SEP电活动波形消失,正中神经和尺神经比较,两组差异均有统计学意义(χ^2值分别为20.613、20.613,P均<0.001)。结论MCA脑梗死病灶所支配的对侧上肢正中神经和尺神经SEP明显异常改变,主要表现为N20�Objective To observe the changes of somatosensory evoked potential(SEP)in the upper limbs of patients with acute middle cerebral artery(MCA)cerebral infarction,and to explore its relationship with neurological impairment.Methods From January 2015 to December 2016,62 patients with 38 cases of male and 24 women of cerebral infarction who were treated in the department of neurology,Kailuan General Hospital were selected for a retrospectively prospective cohort study,including 38 males and 24 females.aged(66.7±10.9)years old and ranging from 33.0 to 85.0 years old.According to the side of cerebral infarction,37 cases were divided into left MCA group and 25 cases into right MCA group.During the 48 hours of admission,the electromyography evoked potential meter was used to detect the upper limb SEP,and the peak latency,amplitude and electrical activity waveform of the cerebral cortex potentials N20,P25 and N35 were recorded.Results The results of SEP in the contralateral limbs of the left and right MCA cerebral infarction group were as follows:1 case(2.70%)and 5 cases(20.00%)of normal median nerve;36 cases(97.30%)and 20 cases(80.00%)of abnormality.The ratio of median nerve abnormalities in the group was statistically significant(χ^2=12.577,P<0.001).The ulnar nerve was normal in 3 cases(8.11%),4 cases(16.00%);34 cases(91.89%)and 21 cases(84.00%)were abnormal.There was no statistically significant difference between the two groups(χ^2=2.320,P=0.128).The peak latency and/or amplitude of each peak decreased in 34 groups(60.71%)and 33 cases(60.00%)of the ulnar nerve;the waveform of electrical activity disappeared,22 cases(39.29%)of median nerve and 22 cases of ulnar nerve(40.00%).The peak latency and/or amplitude decreased,the electrical activity waveform disappeared,and the median nerve and ulnar nerve were compared,and the difference was not statistically significant(χ^2=0.021,P=0.885).The National Institue of Health Storke Scale(NIHSS)scores of left and right MCA cerebral infarction group were 34(91.89%)and 19(76.00%)

关 键 词：躯体感觉诱发电位 脑梗死 大脑中动脉 神经功能 

分 类 号：R74[医药卫生—神经病学与精神病学]