脑卒中偏瘫患者健侧肢体正中神经的F波参数变化

Alteration of F-wave parameters in the unaffected side median nerve of stroke patients with unilateral hemiplegia

目的:观察脑卒中偏瘫患者健侧肢体神经生理学变化特点。方法:于2004-07/2005-03选择吉林大学第一医院神经内科收治并经颅脑CT或MRI确诊的首次住院的脑卒中偏瘫患者80例为观察对象,格拉斯哥昏迷量表评分>8,生命体征平稳。正常对照组来源于门诊健康检查的正常人19例。根据BRSS分级标准,将80例脑卒中偏瘫患者分为3组,BRSSⅠ～Ⅱ级组36例,BRSSⅢ～Ⅳ级组23例,BRSSⅤ～Ⅵ级组21例。应用肌电图技术测试其健侧肢体正中神经的F波参数,连接记录电极(姆短展肌肌腹)、参考电极(第一指骨)与地极。刺激电极置于腕关节正中处,刺激强度为阈刺激的130%,刺激频率为2Hz,电流脉宽为0.2ms,时程为5ms,灵敏度为2mV,依次检测患侧肢体的安静状态(静态)、对侧最大抗阻收缩状态(动态)下健侧正中神经的F波情况,记录F波波幅与频率。结果:所有患者均完成检测,全部进入结果分析。①BRSSⅢ～Ⅴ级脑卒中患者的健侧肢体动态下的F波参数增高,明显高于正常对照组,差异有显著性意义眼波幅:(0.8039±0.1573),(0.4067±0.1703)mV,P<0.05演,眼频率:(0.8561±0.2668)%,(0.6500±0.1976)%,P<0.05演,脑卒中患者健侧肢体静态下正中神经的F波参数与正常对照组差异无显著性意义穴P>0.05雪;而BRSSⅠ～Ⅱ级和BRSSⅤ～Ⅵ级脑卒中患者健侧肢体动静态下正中神经的F波参数与对照组比较差异无显著性意义穴P>0.05雪。②BRSSⅠ～Ⅱ级和BRSSⅤ～Ⅵ级脑卒中患者健侧肢体正中神经F波参数动态高于静态,但差异无显著性意义(P>0.05),而BRSSⅢ～Ⅳ级组脑卒中患者健侧肢体正中神经F波参数动态高于静态,差异有显著性意义眼波幅:(0.8039±0.1573),(0.3917±0.1316)mV,P<0.05演,眼频率:(0.8561±0.2668)%,(0.6391±0.2594)%,P<0.05演。③进一步两两比较发现,静态下各组之间F波参数差异无显著性意义,但BRSSⅢ～Ⅳ级组脑卒中患者健侧肢体动态下正中神经F波参数明显低于其他两组,差异有显著性意义眼波幅:(0.8039±0.1573),(0.3951±0.1488),(0.4371±0.1576)mV,P<0.05演,眼频率:(0.8561±0.2668)%,(0.6125±0.2328)%,(0.6571±0.2325)%,P<0.05演。结论:脑卒中后“健侧”肢体可发展为非麻痹侧化。

AIM： To observe the characteristics of neurophysiology in unaffected side of patients with unilateral hemiplegia after stroke. METHODS： Eighty stroke patients with unilateral hemiplegia, who hospitalized in Department of Neurology, the First Hospital of Jilin University from July 2004 to March 2005, were selected and divided into three groups, including 36 cases of BRSS Ⅰ - Ⅱ grade, 23 cases of BRSS Ⅲ-Ⅳ grade, and 21 cases of BRSS Ⅴ-Ⅵ grade. All the patients were diagnosed with brain CT or MRI and scored more than 8 points of Glasgow Coma Scale, with the stable vital signs. While 19 healthy examinees from out-patient clinic were served as controls. F-wave parameters of unaffected side median nerve were determined by electromyogram. Recording electrode （muscle belly of abductor pollicis brevis） and reference electrode （first bone of fingers） were connected with earth pole. Stimulating electrode placed in the center of wrist joint, at the stimulation intensity of 130% threshold stimulus, the stimulation frequency of 2 Hz, current pulse-width of 0.2 ms, course of 5 ms and sensibility of 2 mV. The amplitude and frequency of F-wave were recorded in the affected side median nerve at static phase and opposite maximum resistant contraction （dynamic phase）. RESULTS： All the patients completed the detection and entered the result analysis. ① For stroke patients with BRSS Ⅲ - Ⅳ grade, the F-wave parameters were significantly increased in the unaffected side at dynamic phase compared with the controls [amplitude： （0.803 9±0.157 3）, （0.406 7±0.170 3） mV, P 〈 0.05; frequency： （0.856 1±0.266 8）%, （0.650 0±0.197 6）%, P 〈 0.05]. But, there was no significant difference in the F-wave parameters between stroke patients at static phase and control group, between stroke patients with BRSS Ⅰ - Ⅱ and BRSS Ⅴ - Ⅵ grades and controls （P 〉 0.05）. ② The F-wave parameters of unaffected side median nerve were higher in stroke patients with BRSS Ⅰ - Ⅱ and BRSS Ⅴ - Ⅵ grades of dynamic phase than those of static phase （P 〉 0.05）, while the parameters were also higher in stroke patients with BRSS Ⅲ - Ⅳ grade of dynamic phase than those of static phase, with the significant difference [amplitude： （0.803 9±0.157 3）, （0.391 7±0.131 6） mV, P 〈 0.05; frequency： （0.856 1±0.266 8）%, （0.639 1±0.259 4）%, P 〈 0.05]. ③ Pairwise comparison showed that the F-wave parameters were not significantly different among groups at static phase, but significantly higher in unaffected side median nerve of stroke patients with BRSS Ⅲ - Ⅳ grade at dynamic phase than those of other two groups [amplitude： （0.803 9±0.157 3）, （0.395 1±0.148 8）, （0.437 1±0.157 6） mV, P 〈 0.05; frequency： （0.856 1±0.266 8）%, （0.612 5±0.232 8）%, （0.657 1±0.232 5）%, P 〈 0.05]. CONCLUSION： The unaffected side may develop into unanesthetization after stroke.