同侧记录的正中神经体感诱发电位与脑卒中后上肢运动功能的关系

Relationship among somatosensory evoked potential recorded by ipsilateral cerebral cortex,motor function of upper extremity

目的:探讨正中神经体感诱发电位(SEP)N20'用于脑卒中上肢运动功能评估的可行性。方法:纳入2019年7月至2020年1月就诊于上海市瑞金康复医院42例首次发病、病程1~3个月的脑卒中患者进行双上肢SEP检测,检查前对患侧上肢采用简化Fugl-Meyer运动功能评分(FMA)及改良Barthel指数(MBI)评估患者日常生活活动能力。将患侧肢体对侧大脑皮层记录的SEP记为N20,将患侧肢体的同侧大脑皮层记录的上肢SEP记为N20'。研究N20'潜伏期、波幅与FMA及MBI评分的关系。结果:①N20波未引出时N20'均未引出,而N20引出时仍有18.9%(7/37例)N20'波未引出;N20异常患者N20'均异常,而N20正常患者63.0%(17/27例)N20'异常。②N20'异常患者FMA和MBI评分低于N20'正常者(P<0.05)。N20与N20'潜伏期分别与上肢FMA评分呈负相关,且后者相关性更大(r=-0.375,P=0.023;r=-0.414,P=0.020)。③N20(-)N20'(-)组FMA评分明显高于N20(-)N20'(+)组及N20(+)N20'(+)组(P<0.05),3组MBI评分差异无统计学意义(P>0.05)。④基底节脑卒中N20'未引出率占所有N20'未引出的90.9%(10/11例),基底节脑卒中N20'异常率为95.0%(19/20例)。不同部位脑卒中患者MBI评分差异具有统计学意义(P<0.05)。结论:N20'波可作为观察偏瘫侧上肢功能的一种客观量化的电生理指标。N20结合N20'相对于单一记录N20能更好地反映当前患侧上肢的运动功能情况。

Objective:To investigate the feasibility of assessing the motor function of upper extremity by somatosensory evoked potentials(SEP)N20'in ipsilateral cerebral cortex.Methods:Forty-two patients in Shanghai Ruijin Rehabilitation Hospital from July 2019 to January 2020,who had a first-ever stroke in three months,were enrolled in the study.The SEP was performed in all patients.Before their tests,they had an assessment of simplified Fugl-Meyer assessment of motor recovery after stroke(FMA)and Modified Barthel Index(MBI).The SEP in the contralateral cerebral cortex of the affected limb was recorded as N20,and the SEP in the ipsilateral cerebral cortex of the affected limb was recorded as N20'.The relationship among N20',FMA and MBI was studied.Results:①N20'was not elicited when N20 disappeared,18.9%(7/37 cases)N20'was still not elicited when N20 was existed.②FMA and MBI scores were lower when N20'was abnormal(P<0.05).There was negative correlation between latency of N20 and N20'and FMA(r=-0.375,P=0.023;r=-0.414,P=0.020).③FMA score in N20(-)N20'(-)group was significantly higher than that in other groups(P<0.05).There was no significant difference in MBI score among the three groups.④Stroke in basil ganglia consisted 90.9%in all not elicited N20'(10/11 cases),the abnormal rate of N20'in stroke of basil ganglia was 95.0%(19/20 cases).MBI scores showed significant difference in different site of stroke(P<0.05).Conclusion:N20'could be an objective and quantitative electrophysiological index to observe motor function of upper extremity in hemiplegic side.N20'combined with N20 could better reflect the motor function of upper extremity in stroke.