N2O中毒相关周围神经病患者的神经电生理学研究

The electrophysiological features of peripheral neuropathy in the patients with N2O poisoning

目的:探讨一氧化二氮(N2O)中毒相关周围神经病患者的电生理特征.临床表现、血清学以及影像学特点,以提高临床对N2O中毒的认识。方法:回顾性分析2018年12月至2019年12月于青岛大学附属医院就诊的N2O中毒性周围神经病患者9例,根据接触史分为3组,分别为2个月组、4个月组、6个月组,收集9例患者的临床症状特点、神经电生理及辅助检验检查资料。结果:N2O接触史4个月.6个月的患者,同上肢运动神经相比,下肢运动神经远端潜伏期(DML)延长更显著、远端复合肌肉动作电位波幅(dCMAP)下降程度更大.运动神经传导速度(MCV)下降更显著(P<0.05;P<0.01),感觉神经传导结果异常率普遍低于运动神经传导结果异常率,且下肢神经较上肢神经受损显著(P<0.01)。结论:N2O中毒相关周围神经病的神经电生理表现为运动神经及感觉神经皆受累的轴索损伤、脱髓鞘或混合性轴索与髓鞘损伤,下肢损伤重于上肢,运动神经损伤重于感觉神经,且病变严重程度与接触史时间长度相关。

Objective:To explore the electrophysiological,elinical,serological and imaging fea-tures of peripheral neuropathy caused by N2O poisoning in order to improve the clinical treatment of N2O poisoning.Methods:Nine patients with N2O toxic peripheral neuropathy treated in the Affiliated Hospital of Qingdao University from December 2018 to December 2019 were retrospectively analyzed.They were divided into 3 groups according to their medical history,including cases of 2 mouths,4 mouths and 6 mouths respectively.The clinical symptoms,neuroelectrophysiology and auxiliary ex-amination of 9 patients were collcted.Results:Compared with the upper limb motor nerves,the distal motor nerve latency of the lower limb motor nerves was prolonged significantly.the distal motor nerve amplitude decreased more significantly,and the motor nerve conduction velocity decreased more signif-icantly(P<0.05),The abnormal rate of sensory nerve conduction was generally lower than that of motor nerve conduction,and the nerve damage of the lower limb was more significant than that of the upper limb(P<0.05).Conclusions:The electrophysiological manifestations of N2 O poisoning related peripheral neuropathy were axonal injury,demyelination or mixed axonal and myelin injury involving both motor and sensory nerves,lower limb injury was more severe than upper limb injury,motor nerve injury was more severe than sensory nerve injury,and the severity of the lesion was related to the length of contact history.