表面肌电对痉挛型脑瘫儿童早期诊断及疗效评估的研究

发布时间：2018-06-03 19:22

本文选题：脑瘫 + 运动功能　；参考：《安徽医科大学》2013年硕士论文

【摘要】：目的探讨表面肌电（sEMG）运动单位动作电位（MUAP）的平均发放间隔（IPI）在痉挛型脑瘫儿童早期诊断及疗效评估中可行性。方法1.选取符合纳入和排除标准的64例9～160个月痉挛型脑瘫患儿为实验组，采用中文版粗大运动功能测试(GMFM88项)和分级系统(GMFCS)、临床痉挛指数（CSI）等进行粗大运动功能和痉挛程度的评定，同时利用表面肌电技术结合力学加速度计，应用课题组前期建立的基于经验模态分解(EMD)的三级滤波器技术和平滑非线性能量算子算法（SNEO算法），计算脑瘫患儿运动单位动作电位（MUAP）的平均发放间隔(IPI)，结合性别、月龄、GMFM-88项总评分、GMFCS分级结果及痉挛程度同对应的IPI进行统计学相关分析处理，探讨临床常用评估方法与表面肌电MUAP的IPI的相关性。 2.通过上述相关分析，探讨影响运动单位动作电位的IPI相关性因素，采用回归统计处理，建立适合的回归模型，为IPI参数量化作为评估指标奠定基础性的研究。 3.参照实验组性别、月龄为基线选取正常儿童64例作为对照组，应用表面肌电技术，测定其运动单位动作电位（MUAP）的平均发放间隔(IPI)，对两组数据的IPI行t检验对比分析。 4.选取围产期脑损伤儿20例作为预测实验组，20名正常新生儿为预测对照组，分别在足月龄4周、8周、16周行全身运动的表面肌电技术评估，实验预测组校正年龄3月内行头颅影像学检查评估，并随访至12月龄，总结明确诊断脑瘫的人数，计算两组患儿三次测定的运动单位动作电位的IPI平均值；分析脑瘫患儿全身运动的表面肌电特性，，探讨IPI在脑瘫早期诊断中的应用价值。结果1.表面肌电信号的IPI与GMFCS分级、痉挛亚型、痉挛指数及痉挛程度呈正相关的关系（rs分别为0.903、0.527、0.663、0.499，P0.001）；与GMFM-88项总评分呈负相关的关系（rs为-0.744，P0.001），均具有统计学意义；与月龄及性别无明显相关性（P0.05）。 2.脑瘫患儿表面肌电IPI与痉挛指数及运动功能评分的逐步回归方程为=6.019+1.011X1-0.66X2（、X1、X2分别代表IPI、痉挛指数、GMFM88项总评分），R2=0.642。 3.实验组与对照组儿童表面肌电MUAP的IPI差异具有统计学意义（P0.05）。 4.围产期脑损伤儿20例中，16例发展为脑瘫；预测实验组与对照组儿童表面肌电MUAP的IPI差异无明显统计学意义（P0.05）。结论1.基于经验模态分解(EMD)的三级滤波器技术和SNEO算法,计算出的表面肌电信号MUAP的IPI与脑瘫儿童的痉挛状态、运动功能密切相关，可以作为痉挛型脑瘫患儿的客观性、综合性的量化疗效评估指标。 2.表面肌电技术在围产期脑损伤儿全身运动评估中具有一定的预测价值，但其运动单位动作电位的IPI尚不能成为脑瘫早期诊断的有效评估指标。
[Abstract]:Objective to investigate the feasibility of the mean release interval IPI (IPI) of motor unit action potential (MUAPP) in children with spastic cerebral palsy. Method 1. A total of 64 children with spastic cerebral palsy from 9 to 160 months were selected as experimental group. The Chinese version of GMFM88 test was used to evaluate the gross motor function and the clinical spasticity index (CSI) of GMFCSA and the clinical spasticity index (CSI) were used to evaluate the motor function and the degree of spasticity in 64 children with spastic cerebral palsy at 9 ~ 160 months in accordance with the criteria of inclusion and exclusion. At the same time, using surface electromyography technology combined with mechanical accelerometer, The three-level filter technique based on empirical mode decomposition (EMD) and the smoothing nonlinear energy operator algorithm (Sneo) were used to calculate the mean release interval of motor unit action potential (MUAPP) in children with cerebral palsy. The results of GMFM-88 total score and the degree of spasticity were statistically correlated with the corresponding IPI, and the correlation between the commonly used clinical evaluation methods and the IPI of surface electromyography (MUAP) was discussed. 2. Through the above correlation analysis, the IPI correlation factors affecting the motor unit action potential are discussed, and the regression statistical treatment is adopted to establish a suitable regression model, which lays a foundation for the study of quantification of IPI parameters as an evaluation index. 3. According to the sex of the experimental group, 64 normal children were selected as the control group. The mean release interval of motor unit action potential (MUAPP) was measured by surface electromyography. The IPI data of the two groups were analyzed by t test. 4. Twenty neonates with perinatal brain injury were selected as the predictive control group, 20 normal newborns were used as the predictive control group, and the surface electromyography (EMG) technique of the whole body movement was evaluated at 4 weeks, 8 weeks and 16 weeks, respectively, at the age of 4 months, 8 weeks and 16 weeks, respectively. The experimental prediction group was evaluated with cranial imaging within 3 months of age and followed up to 12 months of age. The number of children diagnosed with cerebral palsy was summarized and the IPI mean value of motor unit action potential measured three times in both groups was calculated. To investigate the value of IPI in the early diagnosis of cerebral palsy, the surface electromyography of children with cerebral palsy was analyzed. Result 1. There was a positive correlation between IPI and GMFCS grade, spasm subtype, spasticity index and degree of spasticity. Rs was 0.903 / 0. 527 / 0. 663rs / 0. 499p 0.001and negatively correlated with total GMFM-88 score (P = -0. 744 / P0. 001), respectively, and had no significant correlation with age and sex (P 0. 05). 2. The stepwise regression equation of surface electromyography (IPI), spasticity index and motor function score in children with cerebral palsy was 6.019 1.011X1-0.66X2 + X1X2, respectively. The total score of spasticity index (GMFM88) was 0.642. 3. There was significant difference in IPI of MUAP between the experimental group and the control group (P 0.05). 4. Among the 20 cases of perinatal brain injury, 16 cases developed cerebral palsy, and there was no significant difference in IPI of surface myoelectric MUAP between the experimental group and the control group (P 0.05). Conclusion 1. Based on empirical mode decomposition (EMD) three-level filter technique and SNEO algorithm, the calculated IPI of surface electromyography (MUAP) is closely related to spasticity and motor function of children with cerebral palsy, and can be regarded as objectivity of children with spastic cerebral palsy. Comprehensive quantitative evaluation index of curative effect. 2. Surface myoelectric technique has certain predictive value in the evaluation of perinatal brain injury, but the IPI of motor unit action potential can not be an effective index for the early diagnosis of cerebral palsy.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R742.3

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