脑卒中偏瘫患者上肢周围神经的神经电生理分析

Neuroelectrophysiological Analysis of Peripheral Nerves in Upper Limbs of Stroke Patients with Hemiplegia

目的:通过对脑卒中患者健患侧上肢F波的观察和健康人及脑卒中患者上肢神经传导的研究,了解脑卒中偏瘫患者上肢周围神经的神经电生理变化特点。方法:选择符合入选标准的37例脑卒中偏瘫患者作为观察组,并选择37例健康受试者作为对照组,两组均采集双侧正中、尺神经神经传导的波幅、潜伏时、传导速度,同时观察组采集双侧正中神经F波的最短潜伏时、平均波幅、F/M比值、出现率,运用上肢Fugl-Meyer量表(FMA-UE)评估观察组患侧上肢的肢体功能,并对数据进行统计学分析。结果:(1)与健侧相比,患侧F波的最短潜伏时延长,正中、尺运动神经混合肌肉动作电位(CMAP)波幅、运动神经传导速度降低(P<0.05)。(2)与对照组相比,健侧正中神经电位波幅降低、潜伏时延长,尺神经电位潜伏时延长,尺感觉神经电位波幅降低,正中感觉神经传导速度降低(P<0.05)。(3)偏瘫侧FMA-UE评分与患侧尺运动神经CMAP的波幅、尺运动神经患侧与健侧CMAP的波幅比呈正相关(P<0.05)。结论:脑卒中偏瘫患者常伴有双侧周围神经受损,且偏瘫侧上肢运动神经受损程度与该侧上肢运动功能障碍程度具有一定相关性,因而在脑卒中康复中应注意评估并改善周围神经的功能。

Objective: To research the electrophysiological changes of peripheral nerves in the upper limbs of stroke patients with hemiplegia through F-wave in bilateral upper limbs of stroke patients and nerve conduction study in healthy people and stroke patients. Methods: 37 cases of hemiplegic patients with stroke were selected as the observation group, and 37 cases of healthy subjects were selected as the control group. Amplitude, latency and conduction velocity of nerve conduction in bilateral median and ulnar nerves were collected between two groups. At the same time, shortest latency,mean amplitude, F/M Amp Ratio and persistence of bilateral median nerves in the observation group were collected. The upper limb function of the affected side in the observation group was evaluated by Fugl-Meyer scale(FMA-UE), and the data were statistically analyzed. Results:(1) Compared with the healthy side, the shortest latency of F-wave was prolonged, the compound muscle action potential amplitude and motor nerve conduction velocity of median and ulnar motor nerves were decreased in the affected side(P<0.05).(2) Compared with the healthy control group, the action potential latency of median and ulnar nerves prolonged, the action potential amplitude of median nerve and ulnar sensory nerve decreased, and the conduction velocity of median sensory nerve decreased in the contralateral side(P<0.05).(3) The Fugl-Meyer score of hemiplegic upper limb was positively correlated with the compound muscle action potential amplitude of ulnar motor nerve in the affected side and the compound muscle action potential amplitude ratio of ulnar motor nerve between the affected side and the healthy side(P<0.05). Conclusion: Stroke patients with hemiplegia often have bilateral peripheral nerve damage, and the degree of motor nerve damage on the hemiplegic side of the upper limb has a certain correlation with the degree of motor dysfunction of the upper limb. Therefore, attention should be paid to the evaluation and improvement of peripheral nerve function in stroke rehabilitation.