磁刺激运动诱发电位对高位颈髓损伤膈肌功能的评定

Studying the diagnosis and prognostic evaluation of diaphragm function in the patients with upper cervical spinal cord injuries with magnetic stimulated MEP

目的:评定磁刺激运动诱发电位(MEP)对高位颈髓损伤患者膈肌功能状态及呼吸功能预后的价值。方法:采用MagⅠ型磁刺激仪对12例高位颈髓损伤患者进行经颅及颈部刺激,于腋前线第8肋骨插入同心圆针电极达膈肌,记录MEP,收集患者的临床资料。观察患者膈肌MEP的变化与呼吸功能变化的相关性。并以10例健康志愿者作对照。结果:12例高位颈髓损伤患者受伤后各时间段的膈肌MEP皮层潜伏期及中枢传导时间(CMCT)均延长,与对照组相比差异有显著性(P<0·05)。在损伤早期经颈刺激MEP潜伏期与正常对照组相比,无明显变化(P>0·05),但是后期明显比正常对照组延长。结论:脊髓损伤早期,皮层潜伏期较正常显著延长提示患者膈肌功能障碍,出现呼吸衰竭的可能性大;损伤后期经颈刺激膈肌MEP潜伏期明显延长,提示患者只能长期依赖人工呼吸机辅助呼吸,可作为安装膈肌起搏器的可靠依据。

Objective： To study the diagnosis and prognostic evaluation of diaphragm function in the patients with upper cervical spinal cord injuries with magnetic stimulated MEP. Methods： 12 patients with upper cervical spinal cord injuries were performed with the transcranial and transcervical magnetic stimulator of type Mag Ⅰ （Dantec,Denmark）.The MEP was recorded through the electrode, which was inserted into the diaphragm along the superior border of the 8th rib and the anterior axial line. The relation between the changes of the diaphragm and the respiratory function was studied. The other 10 healthy volunteers were adopted as control group. Results：The respective latent periods of the MEPs and the CMCF were all lengthened in the 12 patients. There was a significant difference compared with ttat of the control group （P〈 0.05）. The latent periods of the transcervical MEPs in the early stage of the injury had no obvious change compared with that of the control group, but it prolonged in the late period compared with that of the control group. Conclusion：The longer the early latent period of the cortex, the greater possibility the patients will suffer respiration failure. The patients with the obvious prolongation of the latent period of the MEP in the diaphragm transcervically can only be dependent on the respirators and the diaphragm stimulator can be installed at the later stage.