膈肌肌电图在肌萎缩侧索硬化诊断中的应用及特点

Primary study of diaphragmatic electromyography in amyotrophic lateral sclerosis patients

目的 探讨膈肌肌电图 (DEMG)在肌萎缩侧索硬化 (ALS)患者的应用及特点。方法4 3例ALS患者 ,以同心圆针电极用肋间隙进针法分别记录屏气、平静吸气和深吸气时的膈肌肌电活动 ,并以 2 2块健康膈肌结果为对照。 2 8例患者同时接受用力肺活量百分比 (%FVC)测定。结果 所有受检者均无任何并发症。与对照者相比 ,ALS患者屏气时可见自发电位 ;平静吸气时膈肌运动单位动作电位时限 (12 1ms± 2 7ms)延长、波幅对数 (2 5 9± 0 13)及面积对数 (2 72± 0 2 1)增大、多相波比例 (5 3% )和卫星电位比例 (5 % )增多。有临床呼吸困难患者的时限 (13 6ms± 3 6ms)比无临床呼吸困难的患者 (11 6ms± 2 2ms)长。自发电位与临床呼吸困难与 %FVC相关。结论 针极DEMG能从电生理角度评价ALS患者的呼吸功能 ;时限和自发电位是敏感的指标。

Objective To investigate the features and application of diaphragmatic electromyography (DEMG) in amyotrophic lateral sclerosis(ALS) patients. Methods We recorded the electromyography of 43 diaphrag ms from 43 ALS patients by inserting concentric needle electrode from intercostal space, when they held their breath, breathed smoothly and drew deep breath ,and took electromyography of 22 healthy diaphrag ms as controls. The percentage of forced vital capacity (%FVC) was performed simultaneously in 28 ALS patients. Results All subjects showed no side effect. The spontaneous activities could be found when ALS patients held their breath. During the period of their smooth breath, the duration of their diaphragmatic motor unit action potential(DMUAP)(12.1 ms±2.7 ms) was longer than those of controls, and the common logarithmic value of the amplitude (2.585±0.132) and the area (2.722±0.208) of DMUAP were larger than those of controls. The percentage of polyphasic (53%) and satellite potential (5%) was also increased in ALS patients. The duration(13.6 ms±3.6 ms)of the ALS patients with clinical dyspnoea was longer than that(11.6 ms±2.2 ms)of others without it. The spontaneous activities were correlated with clinical dyspnoea and %FVC. Conclusion DEMG with needle electrode could evaluate the respiratory state of ALS patients at the level of electrophysiology. The duration and the spontaneous activity were its sensitive indexes.