神经电生理对慢性正己烷中毒性周围神经病的随访价值探讨

Value of electrophysiological follow-up for chronic N-hexane intoxication induced peripheral neuropathy

目的探讨神经电生理在慢性正己烷中毒性周围神经病治疗转归随访过程中的实用价值。方法随访15例慢性正己烷中毒性周围神经病患者治疗1年后的神经电生理变化,检查指标包括四肢运动和感觉神经传导功能及上,下肢体感诱发电位(SEP),并与治疗前进行比较。结果与治疗前相比,治疗1年后患者的左侧正中神经、双侧尺神经及右侧腓神经传导速度明显加快(P值均<0．05),右侧尺神经动作电位波幅明显提高(P< 0．05),右侧胫神经末端潜伏期相对缩短(P<0．05),双侧上肢正中神经SEP的N9及N13潜伏期均明显缩短(P值分别<0．05,0．01),N9的波幅明显提高(P值均<0．05);四肢感觉神经传导功能和中枢传导时间(N13-N20)均无明显改善(P值均>0．05)。结论慢性正己烷中毒性周围神经病恢复过程具有神经长度依赖性特点,随访电生理检查具有一定的实用价值。早期以运动神经传导速度的改善及正中神经SEP的N9潜伏期缩短最为明显,SEP在感觉恢复评估方面的敏感性优于感觉神经传导速度。

Objective To investigate the value of electrophysiological changes in follow-up of chronic N-hexane intoxication induced peripheral neuropathy. Methods Fifteen patients with chronic N-hexane intoxication induced peripheral neuropathy were followed up for one year by electrophysiological examination. Standard sensory nerve, motor nerve conduction and somatosensory evoked potentials were performed. Results The motor conductive velocity（MCV） of the median nerve, ulnar nerve and the common peroneal nerve increased in all patients （P all 0.05）. Increased compound muscle action potential（CAMP） amplitude of the ulnar nerve, shortening of distal motor latency（DML） of the posterior tibial nerve and N9 and N13 latency were also found （P〈 0.05 or 0.01）. No change in the sensory nerve conduction and central conduction was seen （P all 〉 0.05）. Conclusion The recovery of the chronic N-hexane intoxication induced peripheral neuropathy depends on the length of the nerve. The electrophysiological examination is useful for evaluating disease evolution with the early increase of MCV and shortening of N9 latency. Somatosensory evoked potentials are more sensitive than the sensory nerve conduction. （Shanghai Med J, 2007, 30 ： 311-314）