电刺激诱发瞬目反射对脑桥梗死患者的预后价值

Prognostic value of electrically elicited blink reflex in patients with pontine infarction

目的探讨电刺激诱发瞬目反射（blink reflex，BR）对脑桥梗死患者的预后价值。方法对43例脑桥梗死患者和37例健康对照组进行电刺激诱发BR的检测，采用欧洲脑卒中评分（The European stroke scale，ESS）和日常生活活动（activity of daily life，ADL）量表对每位患者在BR检查当日和4周末分别进行神经功能缺损程度评分。结果脑桥梗死组病灶侧R1的潜伏期较对照组明显延长，病灶侧R1的潜伏期较健侧也显著延长（P〈0．001）。脑桥梗死组BR各波的异常率以R1最高，占81．4％，而R2和R2＇的异常率分别为23．3％和25．6％。R1的异常率显著高于R2和R2＇（P〈0．001）。双侧脑桥梗死（双侧均有病灶，每侧病灶直径均〉3mm），导致BR各波均未引出。一侧脑桥单个梗死灶，梗死灶直径〉3mm，主要引起R1潜伏期延长；一侧脑桥单个梗死灶，梗死灶直径0．5～3mm，BR各波潜伏期均正常。R1波未引出组神经功能缺损程度最重，ESS评分和ADL评分显著低于R1潜伏期延长组和R1潜伏期正常组（P〈0．001）；R1潜伏期正常组预后最好，4周末其ESS评分和ADL评分均较1周内显著提高（P〈0.01和0．001）；R1潜伏期延长组次之。结论脑桥梗死患者的BR异常以R1潜伏期延长为特征。脑桥的病灶主要引起R1异常，进一步提示R1的反射中枢位于脑桥。BR的异常类型可大致反映脑桥梗死病灶的范围，BR的R1异常可作为脑桥梗死患者神经功能缺损程度和预后评价的电生理指标之一。

Objective To study the prognostic value of electrically elicited blink reflex（BR） in patients with pontine infarction. Methods Electrically elicited BR was tested in 43 patients with pontine infarction and 37 cases of healthy controls. Two neurological functional deficit scales of ESS and ADL were also performed at the same day of BR examimation and after 4 weeks in each patient. Results The latency of R1 in lesion side of pontine infarction group was significantly prolonged than that of healthy control group （P〈0. 001）. The latency of Ra in affected side was also markedly prolonged than that in unaffected side（P〈0. 001）. The abnormal rate of Ra was the highest in pontine infarction group 81.4% among all waves of BR, the abnormal rate of R2 and R2＇ was 23.3% and 25.6%, respectively. The abnormal rate of R1 was significantly higher than that of R2 and R2＇ （P〈0. 001）. All waves of BR were absent in patients with bilateral pontine lesions （diameter〉3mm）. The delayed latency of R1 was mainly observed in patients with unilateral single lesion （diameter〉3mm）. The latencies of all waves of BR were normal in patients with unilateral single lesion（diameter 0.5-3mm）. The group with R1 absence had the most severity of neurological functional deficit, and the score of ESS in this group was markedly lower than that in the group with prolonged latency of R1 （P〈0. 001） and in the group with normal latency of R1 （P〈0. 001） ,respectively. The score of ADL in the group with R1 absence was also significantly lower than that in the group with delayed latency of R1 （P〈0. 001）and in the group with normal latency of R1 （P〈0. 001）. The clinical outcome was the best in the group with normal latency of R1 , and the scores of ESS and ADL after 4 weeks were significantly increased compared with that within the first week of onset of pontine infarction （P〈0.01 and 0. 001） in this group . The group with delayed latency of R1 had worse outcome,and the group with R1 absence had the worst. Conclusion Abnormal BR in patients with pontine infarction characterizes as prolonged latency of R1, The pontine lesion mainly induces R1 abnormality. The result further suggests that the central part of R1 reflex arc is located in pons. The abnormal types of BR can objectively reflect the range of pontine infarction lesion. R2 abnormality of BR may be used as one of electrophysiological indexes to assess neurological functional deficit scale and outcomes in patients with pontine infarction.