交感皮肤反应在神经病理性疼痛中的应用研究

发布时间：2018-05-17 08:41

本文选题：交感皮肤反应 + 神经病理性疼痛　；参考：《大连医科大学》2017年硕士论文

【摘要】：背景目的:交感皮肤反应(Sympathetic skin response,SSR),指的是人体受到一个内源性或外源性刺激,引起交感神经系统的兴奋,导致皮肤表面电压改变,随即出现SSR波形。SSR可检测交感神经节后C类无髓小纤维,目前被用来评估多种疾病的自主神经功能,具有敏感性高、快捷无创、易于操作的优势。目前研究发现,在神经病理性疼痛(Neuropathic Pain,NeP)的发病机制中,异常的交感神经系统发挥了重要作用,其中交感神经节后C类小纤维参与了多个环节。本研究对健康志愿者及NeP患者行SSR检测,目的在于:1.探究NeP患者是否存在自主神经功能紊乱。2.探究NeP患者是否有交感神经节后C类小纤维受损证据。3.研究不同类型NeP之间,如三叉神经痛和带状疱疹相关性疼痛之间的SSR表现是否有差异。4.为NeP的机制研究、诊治探索提供启迪。研究方法:选取21名健康志愿者和41名NeP患者(其中包括14例三叉神经痛患者,14例带状疱疹相关性疼痛患者,21例其他类型NeP患者),平均年龄56-62岁,分别组成对照组、三叉神经痛组、带状疱疹相关性疼痛组、其他NeP组。记录被检者的基础信息和病史。行交感皮肤反应检测:使用上海海神牌肌电图诱发电位仪,记录电极贴于双手心和双足心,参考电极贴于双手背和双足背,地线放在左手腕处,刺激电极阴极朝向远端,放在距腕横纹约3cm处的左正中神经体表投影上,刺激强度30mA,刺激持续时间0.15ms,灵敏度0.5mV/D,随机刺激,测量起始潜伏期值和峰/峰波幅值,得到SSR结果。与对照组相比,病例组SSR异常判定标准:1.未引出波形;2.潜伏期对照组均值+1倍标准差;3.波幅:小于对照组均值的1/2,或对照组均值+1倍标准差。应用SPSS19.0软件统计分析,对不同组间SSR表现行t检验,率的比较用卡方检验,得出结果。当P0.05,提示差异有统计学意义,当P0.01,提示有显著差异。结果:1.对照组和三个疼痛组被检者在年龄、性别方面的差异无统计学意义,可继续比较。2.与对照组相比,三叉神经痛组SSR波幅增高,其中上肢波幅增高,差异具有显著性,(P0.01),下肢波幅增高,差异具有统计学意义,(P0.05),潜伏期无明显延长。3.与对照组相比,带状疱疹相关性疼痛组SSR引出率较低,可引出波幅者其潜伏期延长,其中上肢潜伏期延长,差异具有显著性,(P0.01),下肢潜伏期延长,差异具有统计学意义,(P0.05),波幅无明显减低或增高。4.与对照组相比,其他NeP组潜伏期延长,差异具有显著性,(P0.01),波幅无明显减低或增高。5.四组间SSR波形引出率为:对照组(100%)=三叉神经痛组(100%)其他NeP组(85.7%)带状疱疹相关性神经痛组(64.3%)。率的比较用卡方检验,其他NeP组与对照组间率的比较无统计学意义,P=0.1390.05;带状疱疹相关性疼痛组与对照组间率的比较有统计学意义,P=0.0140.05;带状疱疹相关性疼痛组与其他NeP组率的比较无统计学意义,P=0.1390.05。结论:1.NeP患者存在自主神经功能紊乱,临床上值得关注。2.三叉神经痛者交感神经兴奋性增高。3.带状疱疹相关性疼痛患者可能存在交感神经节后C类无髓小纤维受损,其中带状疱疹者较带状疱疹后神经痛者更明显。4.交感皮肤反应可作为客观的电生理手段来评估疼痛患者的自主神经功能。
[Abstract]:Background Objective: Sympathetic skin response (SSR), which means that the human body is stimulated by an endogenous or exogenous stimulus, causing the excitation of the sympathetic nervous system, causing a change in the surface voltage of the skin, and then the SSR waveform.SSR can be used to detect the unmyelinated small fibers of the C class after the sympathetic ganglion, and is currently used to assess the autonomy of a variety of diseases. Neural function has the advantages of high sensitivity, high sensitivity, shortcut and easy to operate. In the present study, the abnormal sympathetic nervous system plays an important role in the pathogenesis of neuropathic pain (Neuropathic Pain, NeP). Among them, the C class of C is involved in many links after the sympathetic ganglion. This study is a study on healthy volunteers and NeP patients. The purpose of SSR detection was to explore: 1. to explore the existence of autonomic nervous dysfunction in NeP patients and.2. to explore whether NeP patients have C type of small fiber damage after sympathetic ganglion.3. study of different types of NeP, such as the mechanism of the difference of.4. for NeP between the SSR manifestations between trigeminal neuralgia and herpes zoster related pain Provide enlightenment. Study methods: 21 healthy volunteers and 41 NeP patients (including 14 patients with trigeminal neuralgia, 14 patients with herpes zoster related pain, 21 other types of NeP), with an average age of 56-62 years, were composed of a control group, a trigeminal neuralgia group, a herpes zoster related pain group, and other NeP groups. Basic information and medical history. Line sympathetic skin reaction test: using the electromyogram evoked potential instrument of Shanghai sea god brand electromyography, recording electrodes attached to the two hands and bipedal hearts, the reference electrode attached to the back of the hands and the dorsum of the double foot, the ground line on the left wrist, and the electrode cathode toward the distal end, and placed on the left median nerve body about 3cm of the wrist transverse. Stimulated intensity 30mA, stimulation duration 0.15ms, sensitivity 0.5mV/D, random stimulation, measured initial latency and peak / peak amplitude, and obtained the SSR results. Compared with the control group, the SSR abnormal criteria of the case group: 1. did not lead to the waveform; the mean value of the 2. latency control group was +1 times standard deviation; the 3. wave amplitude was less than the mean of the control group 1/2, or the mean value +1 times of the control group. Standard deviation. Using SPSS19.0 software statistical analysis, the SSR performance between different groups was tested by t test. The ratio of the rate was checked with chi square test and the results were obtained. When P0.05, the difference was statistically significant. When P0.01, there were significant differences. Results: there was no statistical difference between the 1. control groups and three pain groups at the age, and the difference was not statistically significant, but continued to be compared. Compared with the control group, the amplitude of SSR in the trigeminal neuralgia group was higher, and the amplitude of upper extremity increased, and the difference was significant, (P0.01), the amplitude of lower extremities increased, and the difference was statistically significant, (P0.05), and the latency period was not significantly prolonged,.3. was lower than the control group, and the SSR elicitation rate of herpes zoster related pain group was lower than that of the control group. The latency delayed the amplitude of.3.. Long, the latent period of upper extremity was prolonged, the difference was significant, (P0.01), the latency of lower extremity was prolonged, the difference was statistically significant, (P0.05), the amplitude of wave amplitude was not significantly reduced or increased.4., compared with the control group, the latency of other NeP groups was prolonged, the difference was significant, (P0.01), the amplitude of wave amplitude was not significantly reduced or increased in the.5. four groups, the rate of waveform extraction was as follows: Group (100%) = trigeminal neuralgia group (100%) other NeP group (85.7%) herpes zoster related neuralgia group (64.3%). Compared with the chi square test, there was no statistical difference between the other NeP group and the control group, P=0.1390.05; the comparison between the herpes zoster related pain group and the contrast group was statistically significant, P=0.0140.05; herpes zoster phase. There was no statistically significant difference in the rate of pain in the group of NeP and other groups. P=0.1390.05. conclusion: 1.NeP patients have autonomic nervous dysfunction, which should be clinically concerned with higher sympathetic excitability in.2. trigeminal neuralgia and.3. herpes zoster associated pain patients may be impaired in the C type of unmyelinated small fibers after the sympathic deity, including blisters. Rash is more obvious than herpes zoster neuralgia..4. sympathetic skin response can be used as an objective electrophysiological method to assess the autonomic nervous function of patients with pain.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R741

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