面肌痉挛患者面神经运动核团的兴奋性研究  

Excitability of facial nerve motor nucleus in patients with hemifacial spasm

作　　者：杨德宝[1] 周世军[1] 王之敏[1] Yang Debao;Zhou Shijun;Wang Zhimin(Department of Neurosurgery,Suzhou Kowloon Hospital,School of Medicine,Shanghai Jiaotong University,Suzhou 215028,China)

机构地区：[1]上海交通大学医学院附属苏州九龙医院神经外科,215028

出　　处：《中华神经医学杂志》2021年第6期617-620,共4页Chinese Journal of Neuromedicine

基　　金：苏州市"科教兴卫"青年科技项目(KJXW2016072);苏州九龙医院培育项目(JL201701)。

摘　　要：目的探讨面肌痉挛患者面神经运动核团的兴奋性是否存在增高,从而佐证面肌痉挛的发病机制。方法对上海交通大学医学院附属苏州九龙医院神经外科自2018年4月至2019年3月应用微血管减压手术治疗的30例面肌痉挛患者,于术中监测其接受单脉冲刺激和多脉冲刺激时患侧、健侧的面神经运动诱发电位(FNMEP)的波幅、刺激阈值电压,并监测患者吸入七氟烷前后FNMEP波幅的改变。结果在患侧可以用单脉冲刺激诱发出FNMEP波形者有26例(89.7%),明显高于健侧(5例,17.2%),差异有统计学意义(P<0.05)。在患侧记录到的FNMEP波幅[(207.2±62.1)μV]与健侧[(180.2±55.0)μV]比较差异无统计学意义(P>0.05),但患侧获得相应波幅的刺激阈值电压[(140.3±26.8)V]却明显低于健侧[(177.0±23.2)V],差异有统计学意义(P<0.05)。患者吸入七氟烷前及吸入七氟烷的0.5、1.0倍最低肺泡浓度时,患侧的FNMEP波幅分别为(207.2±62.1)μV、(133.0±36.5)μV、(70.4±40.2)μV,两两比较差异均有统计学意义(P<0.05)。结论面肌痉挛患者患侧存在面神经运动核团的兴奋性增高,这在一定程度上佐证了面肌痉挛发病的中枢学说。Objective To study whether the excitability of facial nerve motor nucleus is increased in patients with facial spasm to further study the mechanism of facial spasm.Methods Thirty patients with HFS underwent MVD in our hospital from April 2018 and March 2019 were chosen in our study.The amplitude and threshold voltage of facial nerve motor evoked potential(FNMEP)of the affected side and healthy side were monitored and compared by using monopulse stimulation and multi-pulse stimulation.The changes of FNMEP amplitude in patients before and after sevoflurane inhalation were monitored.Results Stable facial motor evoked potential could be stimulated by monopulse in 26 patients(89.7%)on the affected side,while only 5 patients(17.2%)on the healthy side,showing statistical difference between the two sides(P<0.05);there was no significant difference in FNMEP amplitude between the affected side and the healthy side([207.2±62.1]μV vs.[180.2±55.0]μV,P>0.05);the average threshold voltage of neuromotor evoked potential on the affected side was(140.3±26.8)V,which was significantly lower than that in the healthy side([177.0±23.2]V,P<0.05).The amplitude of FNMEP on the affected side was(207.2±62.1)μV,(133.0±36.5)μV,and(70.4±40.2)μV,respectively,before sevoflurane inhalation,and at 0.5 fold of minimun alveolar concentration(MAC)and 1.0 fold of MAC concentrations,with significant differences(P<0.05).Conclusion In patients with hemifacial spasm,there is increased excitability of facial nerve motor nucleus on the affected side,which to a certain extent supports the central theory of hemifacial spasm pathogenesis.

关 键 词：面肌痉挛 面神经运动诱发电位 面神经核团兴奋性 发病机制 

分 类 号：R745.12[医药卫生—神经病学与精神病学]