接触性热痛诱发电位对丘脑梗死脊髓丘脑束功能的初步研究

发布时间：2018-04-12 21:29

本文选题：接触性热痛诱发电位 + 丘脑梗死　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:丘脑梗死是神经内科常见的疾病之一。尽管头部MRI等影像学检查能精确地作出解剖学相关定位诊断,但无法对患者脊髓丘脑束的功能情况进行定量分析。接触性热痛诱发电位(contact heat evoked potentials,CHEPs)利用在一定范围内迅速升高温度的刺激器刺激皮肤的感觉神经末梢,能够选择性识别、刺激薄髓鞘Aδ纤维和无髓的C纤维的伤害性感觉传递功能,进而检测痛觉传导通路的变化特点,是一种较新的用于检查痛觉障碍及脊髓丘脑束功能的非侵入性客观方法。本文应用CHEPs技术研究丘脑梗死患者痛觉传导通路中脊髓丘脑束功能的变化特点,探讨CHEPs检测技术及Aδ纤维传导速度在丘脑梗死中的应用价值,并为丘脑梗死的电生理诊断提供参考依据。方法:按照下文纳入标准及排除标准共收集2014年1月至2016年12月期间于吉林大学中日联谊医院就诊的受试者55例,其中单纯丘脑梗死患者24例,丘脑梗死合并糖尿病患者9例,糖尿病(diabetes mellitus,DM)患者12例,无糖尿病、丘脑梗死的正常对照组10例。应用接触性热痛诱发电位刺激器,以54.5℃的恒定刺激温度,对患者上肢前臂掌侧近端1/3处、颈部C7棘突,胸椎T12棘突,小腿等皮肤进行热痛刺激,受试者经热痛刺激3-5s后,按照视觉模拟评分法(visual analogue scale,VAS),对刺激强度进行评级(1~10级)。CHEPs记录位点位于Fz、Cz和Pz,记录其CHEPs波形、潜伏期,并计算出Aδ纤维传导速度。同时对入选患者进行SCV、MCV等测定,将其结果与CHEPs进行比较分析。结果:1、cheps波形能稳定而可靠的引出。不同组间cheps异常率比较差异有统计学意义(p0.05)。不同组间cheps潜伏期比较差异有统计学意义:dm组、丘脑病变+dm组、丘脑梗死组位于前臂内侧、胫前外侧的cheps潜伏期较正常对照组延长,差异有统计学意义(p0.05)。c7不同组间差异无统计学意义(p0.05)。2、cheps潜伏期与丘脑梗死的病灶大小、主观感觉障碍的比较中,差异有统计学意义(p0.05);cheps潜伏期与丘脑梗死的侧别比较,差异均无统计学意义(p0.05)。3、dm组、丘脑病变+dm组aδ纤维脊髓段传导速度、外周段传导速度较正常对照组减慢,差异有统计学意义(p0.05),丘脑梗死组与正常对照组的cheps脊髓段传导速度、外周段传导速度比较差异无统计学意义(p0.05)。4、dm组cheps异常率明显大于mcv异常率,差异有统计学意义(p0.05)。不同组间mcv比较,差异具有统计学意义:dm组、丘脑病变+dm组与正常对照组正中神经波幅、胫神经传导速度、胫神经波幅降低/减慢,差异具有统计学意义(p0.05),丘脑梗死组与正常对照组比较差异无统计学意义(p0.05)。不同组间scv比较,差异具有统计学意义:dm组、丘脑病变+dm组与正常对照组正中神经波幅、腓浅神经传导速度、腓浅神经波幅降低/减慢,差异具有统计学意义(p0.05),丘脑梗死组与正常对照组比较差异无统计学意义(p0.05)。5、不同组间治疗前vas评分,差异具有统计学意义:丘脑梗死组、丘脑病变+dm组、dm组在治疗前vas较正常对照组降低,差异有统计学意义(p0.05)。不同组间治疗后vas评分,差异无统计学意义(P0.05)。CHEPs波形正常的患者,其治疗前后的VAS的变化较CHEPs波形异常的患者治疗前后变化更显著,差异具有统计学意义(P0.05)。结论:1、丘脑梗死患者存在痛觉传导通路脊髓丘脑束功能受累,但未影响痛觉传导通路的脊髓段、周围段,仅影响了中枢段。2、定点(前臂内侧、胫前外侧)CHEPs测定有助于判断脊髓丘脑束功能的损害。3、CHEPs对丘脑梗死患者的感觉障碍具有客观指示作用,对于丘脑梗死与局部神经病变的鉴别诊断及发现亚临床病变有一定帮助。4、丘脑梗死患者的早期治疗效果与CHEPs异常率有关,CHEP波形基本正常的患者痛觉传导通路损伤较小,早期治疗效果较好。
[Abstract]:Objective: thalamic infarction is one of the most common neurological diseases. Although the head MRI imaging can accurately make anatomic diagnosis, but is unable to function in patients of the spinothalamic tract were quantitatively analyzed. The contact heat evoked potential (contact heat evoked potentials, CHEPs) using the stimulator rapid temperature increase in a certain range in the stimulation of sensory nerve endings in the skin, can selectively recognize, transfer function of sensory stimulation thin myelinated and unmyelinated fiber A 8 C fiber damage, and to detect changes in the pain pathway characteristics, is a relatively new method for objective noninvasive pain disorders and spinothalamic tract function. The change characteristics of spinothalamic tract function using CHEPs Technology to study the thalamic infarction patients pain pathway in the study of CHEPs detection technology and A delta fiber conduction velocity in the high The application value of cerebral infarction, and to provide reference for electrophysiological diagnosis of thalamic infarction. Methods: according to the 55 subjects below the inclusion criteria and exclusion criteria were collected from January 2014 to December 2016 during the visit to Japan Union Hospital of Jilin University, including simple thalamic infarction in 24 patients with thalamic infarction patients with diabetes in 9 cases. Diabetes (diabetes mellitus, DM) in 12 cases, patients without diabetes, the normal control group of 10 cases of thalamic infarction. Application of the contact heat evoked potential stimulator, stimulating constant temperature to 54.5 DEG C, the upper limb in patients with volar forearm proximal 1/3, C7 cervical spinous process, thoracic spinous process of T12, calf skin heat pain stimulation, subjects with thermal pain after 3-5s stimulation, according to visual analogue scale (visual analogue scale, VAS), rating of stimulus intensity (1~10).CHEPs recording sites located in Fz, Cz and Pz, the CHEPs wave records The shape, incubation period, and calculate the A delta fiber conduction velocity. At the same time for SCV patients, MCV were measured, the results were compared with CHEPs. Results: 1, cheps waveform can be stable and reliable. Leads to the abnormal rate of cheps among different groups had significant difference (P0.05) was statistically significant. Cheps latency differences between different groups: DM group, +dm group of thalamic lesions, thalamic infarction group is located in the medial forearm, anterior lateral cheps latency compared with normal control group increased, the difference was statistically significant (P0.05) differences of.C7 among different groups was statistically significant (P0.05).2, cheps latency and thalamic infarction lesion size comparison, subjective sensory disturbance, the difference was statistically significant (P0.05); cheps latency and thalamic infarction side comparison showed no significant difference (P0.05).3, DM group, +dm group of thalamic lesions a delta fiber segment of the spinal cord conduction velocity of peripheral segment The conduction velocity slowed down compared to the normal control group, the difference was statistically significant (P0.05), cheps spinal cord conduction velocity of thalamic infarction group and normal control group, no significant difference between the conduction velocity of peripheral segment (P0.05).4, DM group, the abnormal rate of cheps was significantly higher than the rate of abnormal MCV, the difference was statistically significant (P0.05). Comparison of MCV between different groups, the difference was statistically significant: DM group, +dm thalamic lesion group and normal control group the median nerve amplitude of tibial nerve conduction velocity, tibial nerve amplitude decreased / slow, the difference was statistically significant (P0.05), thalamic infarction group and normal control group had no significant difference between SCV (P0.05). Among different groups, the difference was statistically significant: DM group, +dm thalamic lesion group and normal control group the median nerve amplitude, superficial peroneal nerve and superficial peroneal nerve conduction velocity, amplitude decreased / slow, the difference was statistically significant (P0.05), thalamus. The death group and normal control group had no significant difference (.5, P0.05) among different groups before treatment VAS score, the difference was statistically significant: thalamic infarction group, thalamic lesions in the +dm group, DM group before the treatment of vas is lower than normal control group, the difference was statistically significant (P0.05). Different groups after treatment, vas the score, the difference was not statistically significant (P0.05) in patients with normal.CHEPs waveform, changes before and after the treatment of VAS patients before and after treatment with CHEPs wave abnormal changes more significantly, the difference was statistically significant (P0.05). Conclusion: 1, thalamic infarction patients have pain pathway of spinothalamic tract dysfunction, but did not affect the spinal cord section, the pain pathway around, only affects the central segment of.2 point (the inner side of the forearm, anterior lateral) determination of CHEPs is helpful in judging the spinothalamic tract dysfunction.3 CHEPs sensory disturbance on the thalamus infarction with objective Indication, for differential diagnosis of thalamic infarction and the local nerve lesions and discover subclinical lesions have helped.4, the effect of early treatment with CHEPs in patients with thalamic infarction and abnormal rate of the CHEP waveforms in patients with normal pain pathway of minor injury and early treatment effect is good.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.33

【相似文献】