氧化亚氮相关周围神经损害临床与电生理特点  

Clinical and Electrophysiological Characteristics of Nitrous Oxide Associated Peripheral Neuropathy

作　　者：何正卿 白炯明 王浩然 杨飞[3] 王红芬[3] 陈朝晖[3] 凌丽[3] 程宏梅 黄旭升 HE Zhengqing;BAI Jiongming;WANG Haoran;YANG Fei;WANG Hongfen;CHEN Zhaohui;LING Li;CHENG Hongmei;HUANG Xusheng(Senior Department of Neurology,the First Medical Center of PLA General Hospital,Beijing 100036,China)

机构地区：[1]解放军医学院,北京100036 [2]南开大学医学院 [3]解放军总医院第一医学中心神经内科

出　　处：《中国神经精神疾病杂志》2021年第8期455-460,共6页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的探究氧化亚氮相关周围神经损害的临床及电生理特点。方法回顾性收集氧化亚氮相关周围神经病(病例组)8例和维生素B12缺乏相关周围神经(病例对照组)24例,对一般资料、病史、血常规、血生化检查、脑脊液化验及神经电生理检查结果进行比较分析。结果两组患者常见症状为下肢麻木、无力及步态不稳。病例组血红蛋白[(146.5±22.5)g/L vs.(127.5±22.6)g/L]、肌酸激酶[165.9(67.9,339.7)U/L vs.62.4(34.9,113.1)U/L]、尿酸[392.9(358.1,500.4)μmol/L vs.293.8(259.5,367.0)μmol/L]高于病例对照组。运动神经传导检查,病例组的双侧胫神经[波幅L:0.2(0,0.9)mV vs.7.1(3.2,10.3)mV;R:0.3(0,0.9)mV vs.6.9(2.7,10.2)mV;速度L:15.3(0,36.3)m/s vs.40.2(36.7,43.4)m/s;R:15.7(0,34.0)m/s vs.39.8(33.3,43.2)m/s]、腓总神经[波幅L:0.1(0,0.6)mV vs.2.7(1.0,5.0)mV;R:0(0,1.7)mV vs.2.8(1.7,4.0)mV;速度L:15.1(0,33.0)m/s vs.40.5(34.0,45.6)m/s;R:0(0,32.2)m/s vs.41.4(35.8,45.1)m/s]远端复合肌肉动作电位波幅、传导速度均低于病例对照组;感觉神经传导检查,病例组的正中神经[波幅L:5.0(2.9,6.5)μV vs.3.1(0,3.6)μV]、尺神经[波幅L:5.0(4.0,7.2)μV vs.2.0(0,3.9)μV]的感觉神经动作电位波幅、双侧腓肠神经[波幅L:8.7(4.5,10.7)μV vs.0(0,2.6)μV;R:8.8(4.7,10.8)μV vs.0(0,2.0)μV;速度L:47.7(44.5,52.7)m/s vs.0(0,46.6)m/s;R:50.0(47.3,53.1)m/s vs.0(0,42.9)m/s]感觉神经动作电位波幅及传导速度均高于病例对照组。结论氧化亚氮相关周围神经损害在临床表现上以运动功能损害为著,神经电生理上主要表现为感觉运动神经病,以运动轴索损害更为突出。Objective To evaluate Clinical and Electrophysiological Characteristics of Nitrous Oxide Associated Peripheral Neuropathy.Methods Eight nitrous oxide(N2O)associated peripheral neuropathy(PN)and 24 vitamin B12 deficiency associated PN were enrolled.Clinical data,hemoglobin,mean corpuscular volume,homocysteine(Hcy),creatine kinase(CK),uric acid,cerebrospinal fluid,and electrophysiological data were compared between two groups.Results Numbness and weakness of lower limbs and unsteady gait were common in both groups.Hemoglobin[(146.5±22.5)g/L vs.(127.5±22.6)g/L],CK[165.9(67.9,339.7)U/L vs.62.4(34.9,113.1)U/L]and uric acid[392.9(358.1,500.4)μmol/L vs.293.8(259.5,367.0)μmol/L]were significantly increased in N2O associated PN.Compound muscle action potentials and conduction velocity of tibial[dCMAP(L):0.2(0,0.9)mV vs.7.1(3.2,10.3)mV;dCMAP(R):0.3(0,0.9)mV vs.6.9(2.7,10.2)mV;V(L):15.3(0,36.3)m/s vs.40.2(36.7,43.4)m/s;V(R):15.7(0,34.0)m/s vs.39.8(33.3,43.2)m/s]and common peroneal nerve[dCMAP(L):0.1(0,0.6)mV vs.2.7(1.0,5.0)mV;dCMAP(R):0(0,1.7)mV vs.2.8(1.7,4.0)mV;V(L):15.1(0,33.0)m/s vs.40.5(34.0,45.6)m/s;V(R):0(0,32.2)m/s vs.41.4(35.8,45.1)m/s]were significantly higher in N2O associated PN than that in vitamin B12 deficiency associated PN.Sensory nerve action potentials(SNAP)of ulnar[L:5.0(4.0,7.2)μV vs.2.0(0,3.9)μV]and median nerve[L:5.0(2.9,6.5)μV vs.3.1(0,3.6)μV],SNAP and velocity of sural nerve[SNAP(L):8.7(4.5,10.7)μV vs.0(0,2.6)μV;SNAP(R):8.8(4.7,10.8)μV vs.0(0,2.0)μV;V(L):47.7(44.5,52.7)m/s vs.0(0-46.6)m/s;V(R):50.0(47.3,53.1)m/s vs.0(0,42.9)m/s]were significantly higher in N2O associated PN than that in vitamin B12 deficiency associated PN.Conclusion N2O associated PN is characterized by prominent motor dysfunction and sensory-motor peripheral neuropathy with prominent motor axonal lesions.

关 键 词：氧化亚氮 周围神经病 神经传导速度 动作电位 

分 类 号：R745[医药卫生—神经病学与精神病学] R741.044[医药卫生—临床医学]