尿毒症患者透析前后周围神经的电生理指标变化

Electrophysiological changes in uremic dialysis patients before and after hemodialysis

目的了解尿毒症患者透析前后周围神经电生理指标的变化。方法选择23例尿毒症透析患者,在透析前后对胫后神经、腓总神经、腓肠神经及皮肤交感反应和血液分别进行检查,对比患者透析前后各项周围神经电生理指标的变化及其与血常规、血生化指标的关系。结果电生理表现主要为F波的潜伏期延长,传导速度减慢,末端潜伏期延长,波幅降低;尿毒症患者透析前与透析后比较:所检神经运动传导、感觉传导及交感皮肤反应潜伏期有统计学差异(P<0.01或P<0.05);胫后神经F波潜伏期与肌酐呈正相关;胫后神经末梢潜伏期与钾呈正相关,其波幅与尿素氮、磷呈负相关;胫后神经的运动传导速度与尿酸呈负相关,其波幅与镁、钾呈负相关;腓总神经感觉传导速度与肌酐、尿酸呈负相关;腓总神经运动传导速度与肌酐呈负相关;腓肠神经感觉传导速度与肌酐、尿素氮呈负相关。结论尿毒症患者透析后周围神经电生理异常程度明显改善,其变化与血液指标变化相适应,神经电生理检查可作为该病进展观察及治疗效果评价的重要指标。

Objective To analyze electrophysiological changes in uremic patients before and after hemodialysis.Methods Twenty-three hemodialysis patients were enrolled and electrophysiological tests were performed before and after hemodialysis,including tibial nerve,peroneal nerve,sural nerve,and the skin sympathetic response.The electrophysiological changes were observed and the relations between electrophysiological parameters and blood parameters in uremic dialysis patients before and after hemodialysis were analyzed.Results The main electrophysiological changes were prolongated F wave latency of tibial nerve,slowing of nerve conduction,prolongated distal latencies,decreased amplitude.Comparison before and after hemodialysis showed that the motor and sensory nerve,skin sympathetic response had a significant difference（P0.01 or P0.05）.The F wave latency of posterior tibial nerve and Cr were positively correlated;the latency of distal posterior tibial nerve and K was positively correlated,with its amplitude and BUN,P negatively correlated.The motor conduction velocity of posterior tibial nerve and UA were negatively correlated,with its amplitude and Mg,K negatively correlated.The sensory conduction velocity of common peroneal nerve and Cr,Bun were negatively correlated;the motor conduction velocity of common peroneal nerve and Cr were negatively correlated.The sensory conduction velocity of sural nerve and Cr,BUN were negatively correlated.Conclusions After hemodialysis the abnormal peripheral neuropathy in uremic patients is improved significantly,its change is in conformity with the change in.Electrophysiological examination can be used as an important auxiliary examination to observe the progression of the disease and to evaluate the therapeutic effect.