卒中后患者上肢体感诱发电位及周围神经电生理特征分析  

Analysis of Upper Limb Somatosensory Evoked Potential and Peripheral Nerve Electrophysiological Characteristics in Patients with Stroke

作　　者：韩雪 张玉梅[1,3] HAN Xue;ZHANG Yumei(Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Rehabilitation Medicine,Electric Power Teaching Hospital of Capital Medical University(Beijing Electric Power Hospital of State Grid Corporation),Beijing 100073,China;Department of Rehabilitation Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,北京100070 [2]首都医科大学电力教学医院(国家电网公司北京电力医院)康复医学科 [3]首都医科大学附属北京天坛医院康复医学科

出　　处：《中国卒中杂志》2023年第3期281-287,共7页Chinese Journal of Stroke

基　　金：国家重点研发项目——老年全周期康复技术体系与信息化管理研究(2018YFC 2002300)分课题“老年常见神经系统疾病综合康复体系研究”(2018YFC 2002302)。

摘　　要：目的 分析卒中后患者上肢体感诱发电位(somatosensoryevokedpotentials,SEP)、周围神经电生理特征与运动功能的相关性。方法 此前瞻性研究连续纳入2018年6月—2022年3月康复科收治的亚急性期卒中患者,采用自身健患侧进行对比,进行双侧上肢SEP和周围神经电生理检查并对患侧上肢运动功能进行评分。分析患侧SEPP15、N20、P25、N13及N9潜伏期、感觉神经传导参数、运动神经传导参数与上肢运动功能等指标的相关性。结果 本研究共纳入卒中后亚急性期偏瘫患者102例,平均(68.76±11.33)岁,男性78例。患者偏瘫侧上肢SEPP15[(16.90±1.67)ms vs.(16.27±1.50)ms,P<0.001]、N20[(20.13±1.49)ms vs.(19.42±1.60)ms,P<0.001]、P25[(24.39±1.75)ms vs.(23.70±1.50)ms,P<0.001]、N13[(14.05±1.25)ms vs.(13.42±1.26)ms,P<0.001]及N9[(9.25±0.96)ms vs.(8.80±1.40)ms,P<0.001]的潜伏期均大于健侧;偏瘫侧上肢正中神经(指1-腕)感觉神经传导速度(sensorynerve conductionvelocity,SCV)[(48.93±6.82)m/s vs.(51.26±6.40)m/s,P<0.001]、波幅[(22.54±9.91)μv vs.(32.71±17.68)μv,P<0.001]小于健侧;正中神经(指3-腕)SCV[(49.26±7.31)m/s vs.(52.98±5.99)m/s,P<0.001]、波幅[(24.71±11.39)μv vs.(38.57±20.21)μv,P<0.001]小于健侧;尺神经(指5-腕)SCV[(48.72±7.46)m/s vs.(52.01±6.82)m/s,P<0.001]、波幅[(19.51±11.35)μv vs.(25.74±13.44)μv,P<0.001]小于健侧;尺神经(腕-肘上)SCV[(54.53±6.06)m/s vs.(56.99±4.84)m/s,P<0.001]、波幅[(11.37±6.04)μv vs.(14.53±7.89)μv,P<0.001]小于健侧。偏瘫侧上肢正中神经(肘-腕)运动神经传导速度(motornerveconductionvelocity,MCV)[(54.79±4.89)m/s vs.(57.10±5.07)m/s,P<0.001]、波幅[(8.42±3.85)μv vs.(10.00±3.72)μv,P<0.001]小于健侧;尺神经(腕-肘上)MCV[(53.12±6.81)m/s vs.(55.01±6.35)m/s,P<0.001]、波幅[(6.89±2.56)μv vs.(8.78±2.26)μv,P<0.001]小于健侧。P15(r=-0.358,P<0.001)、N20(r=-0.674,P<0.001)、P25(r=-0.465,P<0.001)潜伏期与Fugl-Meyer上肢运动功能评定量表(Fugl-MeyerassessmenObjective To analyze the correlation between upper limb somatosensory evoked potential(SEP),peripheral nerve electrophysiological characteristics and motor function in patients with stroke.Methods Patients with subacute stroke admitted to the Department of Rehabilitation from June 2018 to March 2022 were consecutively included in this prospective study.SEP and peripheral nerve electrophysiological examination were performed on both upper limbs,which of the healthy and affected sides were compared,and motor function of the affected side was scored.The correlation of latent period of SEP P15,N20,P25,N13 and N9,sensory nerve conduction parameters,motor nerve conduction parameters of the hemiplegic upper limb and its motor function was analyzed.Results A total of 102 patients were included in this study,with an average age of(68.76±11.33)years and 78 males.The latent period of SEP P15[(16.90±1.67)ms vs.(16.27±1.50)ms,P<0.001],N20[(20.13±1.49)ms vs.(19.42±1.60)ms,P<0.001],P25[(24.39±1.75)ms vs.(23.70±1.50)ms,P<0.001],N13[(14.05±1.25)ms vs.(13.42±1.26)ms,P<0.001]and N9[(9.25±0.96)ms vs.(8.80±1.40)ms,P<0.001]of hemiplegic upper limb were greater than those of the healthy side.The sensory nerve conduction velocity(SCV)[(48.93±6.82)m/s vs.(51.26±6.40)m/s,P<0.001]and amplitude[(22.54±9.91)μv vs.(32.71±17.68)μv,P<0.001]of median nerve(finger 1-wrist)of hemiplegic upper limb were lower than those of the healthy side;median nerve(finger 3-wrist)SCV[(49.26±7.31)m/s vs.(52.98±5.99)m/s,P<0.001]and amplitude[(24.71±11.39)μv vs.(38.57±20.21)μv,P<0.001]of hemiplegic upper limb were lower than those of the healthy side.The SCV[(48.72±7.46)m/s vs.(52.01±6.82)m/s,P<0.001]and amplitude[(19.51±11.35)μv vs.(25.74±13.44)μv,P<0.001]of ulnar nerve(finger 5-wrist)of hemiplegic upper limb were lower than those of the healthy side.The SCV[(54.53±6.06)m/s vs.(56.99±4.84)m/s,P<0.001]and amplitude[(11.37±6.04)μv vs.(14.53±7.89)μv,P<0.001]of ulnar nerve(superior wrist-elbow)of hemiplegic upper limb were lower tha

关 键 词：卒中 上肢 体感诱发电位 感觉神经传导速度 运动神经传导速度 

分 类 号：R743.3[医药卫生—神经病学与精神病学]