脑干梗死患者的面神经F波研究

Study of facial nerve F wave in patients with brainstem infarction

目的研究脑干梗死患者的面神经F波的动态变化,探讨其对脑干梗死急性期的诊断及预后评估的价值。方法纳入我院脑干梗死患者53例,分别于发病3 d、7 d、14 d、1 m、3 m给予电生理检查,包括面神经F波出现率、潜伏期,并与健侧做对比。发病3 m时根据mRS神经功能评分分为预后良好组(mRS评分≤2分)和预后不良组(mRS评分>2分),同时纳入10例健康成年人作对照组,检测方法相同。对比不同时间点面神经F波出现率和潜伏期。结果53例脑干梗死患者分别于发病3 d、7 d、14 d均出现了F波的出现率下降和潜伏期延长,与健侧比较差异有统计学意义(P<0.05);但发病3 m时潜伏期有所恢复,与健侧比较差异不具有统计学意义(P>0.05),而出现率与健侧比较差异仍有统计学意义(P<0.05);不同类型脑干梗死患者分组后发现3 d、7 d各组之间F波出现率和潜伏期都出现了不同程度的下降,差异不具有统计学意义(P>0.05);Raymond-Cestan综合征组于14 d开始F波出现率和潜伏期率先恢复,与其他各组比较差异有统计学意义(P<0.05);Millard-Gubber综合征组于发病1 m、3 m时F波出现率和潜伏期均重于其他组,差异有统计学意义(P<0.05);进行预后分组后发现发病3 d、7 d两组F波潜伏期和出现率增下降,差异不具有统计学意义(P>0.05),14 d开始,预后良好组潜伏期和F波出现率先于预后不良组恢复,差异有统计学意义(P<0.05);于发病3 m时,预后良好组F波出现率明显高于预后不良组,差异有统计学意义;而潜伏期两组都有明显的恢复,差异无统计学意义(P>0.05)。结论脑干梗死患者早期即可出现面神经F波和潜伏期的改变,但急性期对不同类型的脑梗死无鉴别诊断价值,急性期过后可预后评估提供有价值的客观依据。

Objective To study the dynamic changes of facial nerve F wave in patients with brainstem infarction,and to explore its value in diagnosis and prognosis evaluation of acute brainstem infarction.Methods Fifty-three patients with brainstem infarction were enrolled in our hospital.Electrophysiological examinations were performed on the 3rd,7th,14th,1st and 3rd days of onset,including the occurrence rate and latency of facial nerve F wave,and compared with the healthy side.Three months after onset,the patients were divided into good prognosis group(mRS≤2)and poor prognosis group(mRS>2)according to mRS neurological function score,and 10 healthy adults were included as control group with the same detection method.The incidence and latency of facial nerve F wave at different time points were compared.Results 53 patients with brainstem infarction showed a decrease in the occurrence rate of f wave and an extension in the latency period on the 3rd,7th and 14th days of onset respectively,with a statistically significant difference compared with the healthy side(P<0.05).However,the incubation period recovered at 3 months after onset,with no significant difference compared with the healthy side(P>0.05),while the occurrence rate was still statistically significant compared with the healthy side(P<0.05).In patients with different types of brainstem infarction,the occurrence rate and incubation period of f wave in each group decreased to different degrees on the 3rd and 7th day,and the difference was not statistically significant(P>0.05).The occurrence rate and incubation period of f wave in Raymond-Cestan syndrome group first recovered from the 14th day,with significant difference compared with other groups(P<0.05).The occurrence rate and incubation period of f wave in Millard-Gubber syndrome group were higher than those in other groups at the 1st and 3rd month of onset,the difference was statistically significant(P<0.05).On the 3rd and 7th day of onset,the incubation period and occurrence rate of f wave in the two groups increased and decreased,with no significant difference(P>0.05).From the 14th day on,the incubation period and f wave occurrence in the group with good prognosis first recovered in the group with poor prognosis,with significant difference(P<0.05).At the 3rd month of onset,the occurrence rate of F wave in the group with good prognosis was significantly higher than that in the group with poor prognosis,and the difference was statistically significant.However,the incubation period of the two groups had obvious recovery,and the difference was not statistically significant(P>0.05).Conclusion The changes of facial nerve F wave and latency can occur in patients with brainstem infarction in the early stage,but there is no differential diagnosis value for different types of cerebral infarction in the acute stage,which can provide valuable objective basis for prognosis evaluation after the acute stage.