接触性热痛诱发电位的临床研究

Clinical study of the contact heat evoked potentials

目的进一步完善接触性热痛诱发电位（CHEP）的检测方法和检测痛觉传导通路上段脊髓丘脑束和周围段神经传导时间及周围段神经传导速度。方法受检者取卧位，应用CHEP刺激器，于54．5℃应用可调节脉冲，刺激部位为手背、前臂的掌侧面和C7水平皮肤。以Keypoint．net仪器记录．记录点为Cz和Pz。测定CHEP主要波形及外周神经传导速度。结果于记录点记录到2个主要成分：Cz／N550、Cz／P750；刺激手背、前臂掌侧面和C7水平皮肤所得CHEP起始波潜伏期男性女性间比较差异无统计学意义（P〉0．05）；介导此诱发电位的外周神经传导速度为（12．9±7．5）m／s，与A3纤维传导速度相对应。结论主观疼痛能够进行客观测定，C7点刺激进行CHEP测定有助于判断脊髓丘脑束中枢段和周围段的损害。

Objective To search for a method to differentiate the peripherial and central part of spinothalamic tract. Methods The subjects were set on supine position. A heat-foil technology was used to elicit pain and contact heat evoked potentials （CHEP）. Thermal stimuli were sent at 54.5℃ to three body sites： the dorsum of hand, proximal volar forarm and C7. CHEP was recorded from Cz and Pz. The main components of CHEP were watched. Nerve conduction velocity was calculated. Results Two components, Cz/N550 and Cz/P750, were found in the evoked potentials. The latency of CHEP were different when the dorsum of hand, proximal volar forarm and C7 were stimulated respectively. There was no statistical difference between males and females. Nerve conduction velocity of the fiber was （12.9±7.5） m/s which was corresponded to that of Aδ fiber. Conclusion It is suggested that pain evoked potential could be elicited reliably,the stimulation of Cywould help differentiate the lesion of peripherial and central part of spinothalamic tract.