电刺激正中神经所诱发的SNAP-SEP与朝医四象体质之间的关联

发布时间：2018-08-24 14:23

【摘要】：目的：以朝医四象医学为理论依据,通过电刺激正中神经测量体感诱发电位(SEP)和上肢的感觉神经动作电位(SNAP),结合辨象结果,观察分析太少阴阳各象体质的神经传导特点与意义。根据辨象结果,分象整理其神经传导Parameters,比较分析：①四象人的中枢神经传导时间；②四象人的上肢感觉神经传导特点；③SEP与SNAP的相关规律；④左右侧间的神经传导差异、潜在性损伤率。进而全面地掌握电刺激正中神经所诱发的SNAP-SEP与四象体质间的关联,可以提高朝医临床中进行四象人辨象的正确性,进一步指导临床治疗。方法：对检测实验环境的要求与控制：室温维持在26℃左右,室内环境的湿度适中,保持安静。①收集1317位延边大学内的在校大学生作为本次的受试对象,受试对象均为健康人群且没有神经系统的相关疾病,如感觉障碍以及麻木等,而且无相关家族病史。所有受试对象按照随机原则进行分组。甲组：319位学生由157位男生和162位女生组成；学生年龄分布在18岁到35岁之间,平均(19.2±2.3)岁。乙组：998位学生由431位男生和567位女生组成；学生年龄分布在17岁到36岁之间,平均(18.5±2.8)岁。分别检测甲组和乙组同学上肢的体感诱发电位(SEP)和感觉神经动作电位(SNAP)。②所有受试对象根据自身实际特点完成辨象调查表的填写。辨象小组专家根据辨象表及对受试者头面部,正、侧和后面的拍照,以及结合临床工作经验对受试对象进行辨象诊断,对于体质诊断较为困难或诊断结果存在争议的可进一步选择其他方式协助判断,以确保四象人判断的准确。③进行检测前,受试对象在安静的环境中休息5min,保证身体处于放松状态,待受试对象身体恢复平稳后采取平卧位开始进行检测。④对正中神经的SEP进行检测,记录从刺激开始到各诱发成分之间的传导时间及其波形和波幅等。⑤检测上肢感觉神经传导动作电位,记录其潜伏期、波幅、神经传导速度。⑥将四象人同组内及不同组间中枢-上肢末梢感觉神经传导的相关性及差异进行比较。对收集的所有数据进行统计分析,探讨四象各类型的不同脏局所致的内在环境与末梢感觉神经及中枢神经传导的关联性。结果：甲组：①相比于少阴人,太阴人的体重偏重,差异有统计学意义(P0.05);四象人各组间在身高和年龄上没有显著性差异(P0.05)。②太阴人左体N13波和N20波潜伏期间期(N13 Onset-N20 Onset,以下简称N13a-N20a)和波峰间期(N13 Peak-N20 Peak,以下简称N13b-N20b)较右体缩短,其差异有统计学意义(P0.05)。乙组：相比于左侧,右侧SNAP的DD (Distal Duration远端持续时间,以下简称DD)延长(P0.01); DA (Distal Amplitude远端波幅,以下简称DA)降低(P0.001); W-E Dist (Wrist-Elbow Dist腕-肘间的距离,以下简称W-E Dist)短(P0.001); F-W SCV (Finger-Wrist sensory nerve conduction velocity手指-腕间感觉神经传导速度,以下简称F-W SCV)慢(P0.05);W-E SCV(Wrist-Elbow sensory nerve conduction velocity腕-肘间感觉神经传导速度,以下简称W-ESCV)慢(P0.001)。结论：1.中枢神经特点：太阴人的左右侧之间的N13-N20潜伏间期差异,提示颈髓中段的后索、束核或对侧内侧丘索、丘脑及大脑皮层的传导左右侧的传导差异。2.末梢神经特点：健康受试者左右侧之间的SNAP波持续时间DD、波幅DA、腕肘距离W-E Dist、以及传导速度SCV均有差异(P0.05),提示健康成年人的电刺激正中神经所诱发的感觉神经传导左右侧之间存在差异。3.中枢-末梢神经的关系：四象体质中,太阴人的中枢神经传导N13-N20存在左右侧差异。正中感觉神经存在左右侧传导差异,暗示占人口数50%左右的太阴人有关联。中枢-末梢神经均为左侧快于右侧。4.太阴人体质特点：血浊气涩,好静不好动,导致了该体质人神经传导左右体之间传导差异。
[Abstract]:Objective: To observe and analyze the characteristics and significance of nerve conduction of Yin and Yang physique in Tai Shao Yin and Yang physique by Electrostimulating median nerve to measure somatosensory evoked potential (SEP) and sensory nerve action potential (SNAP) of upper extremity. Analysis: 1) Central nerve conduction time of Sixiang people; 2) Sensory nerve conduction characteristics of upper limb of Sixiang people; 3) Correlative regularity of SEP and SNAP; 4) Difference of nerve conduction between left and right sides, potential injury rate. Methods: The requirement and control of the test environment were: the room temperature was maintained at about 26 ~C, the humidity of the indoor environment was moderate, and the indoor environment was kept quiet. All subjects were randomly divided into two groups. Group A: 319 students were composed of 157 boys and 162 girls; the age of the students ranged from 18 to 35 years old, with an average age of (19.2 (+ 2.3) years. Group B: 998 students were 431 boys. And 567 female students aged between 17 and 36, with an average age of 18.5 (+ 2.8) years. The somatosensory evoked potentials (SEP) and sensory nerve action potentials (SNAP) of upper limbs of students in group A and group B were detected respectively. All subjects completed the questionnaire according to their own actual characteristics. The subjects'head and face, front, side and back photographs, as well as the combination of clinical work experience on the subject of image diagnosis, for physical diagnosis is more difficult or controversial results can be further selected to assist in the judgment of other ways to ensure the accuracy of the four elephants. After resting for 5 minutes, the subjects were in relaxed state. The SEP of median nerve was detected in supine position. The conduction time, waveform and amplitude were recorded from the beginning of stimulation to each evoked component. _Sensory nerve conduction action potential of upper limb was detected and its latency was recorded. _Comparing the correlation and difference of central-upper limb peripheral sensory nerve conduction between the same group and different groups. Statistical analysis was made on all data collected to explore the relationship between the internal environment caused by different visceral organs and peripheral sensory nerve conduction and central nerve conduction. Results: Group A: Compared with Shaoyin people, the weight of Taiyin people was heavier, and the difference was statistically significant (P 0.05); There was no significant difference in height and age among the four elephants groups (P 0.05). The latency period of left body N13 wave and N20 wave in Taiyin people (N13 Onset-N20 Onset, hereinafter referred to as N13a-N20a) and N13 Peak-N20 Peak (hereinafter referred to as N13 Peak-N20 Peak). N13b-N20b was shorter than the right body, and the difference was statistically significant (P 0.05). Group B: Compared with the left side, the distal duration of the right SNAP (Distal Duration, hereinafter referred to as DD) was prolonged (P 0.01); the distal amplitude of the DA (Distal Amplitude, hereinafter referred to as DA) was decreased (P 0.001); and W-E Dist (Wrist-Elbow Dist wrist-elbow distance, hereinafter referred to as W-E Dist) Short (P 0.001); F-W SCV (Finger-Wrist sensory nerve conduction velocity between fingers and wrists, hereinafter referred to as F-W SCV) slow (P 0.05); W-E SCV (Wrist-Elbow sensory nerve conduction velocity between wrist and elbow, hereinafter referred to as W-ESCV) slow (P 0.001). Differences in N13-N20 latency between the left and right sides of the cervical spinal cord suggest differences in conduction between the posterior funiculus, fascicular nucleus or contralateral medial colliculus, thalamus and cerebral cortex. (P 0.05), suggesting that there is a difference between the left and right sensory nerve conduction induced by electrical stimulation of the median nerve in healthy adults. 3. The relationship between the central nerve and the peripheral nerve: In the four-figure constitution, there is a difference between the left and right sides of the central nerve conduction N13-N20 in Taiyin people. The central and peripheral nerves are faster on the left than on the right. 4. Physical characteristics of the Taiyin: blood turbidity and astringency, good static and inactive, resulting in the difference of nerve conduction between the left and right bodies.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R29

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