N2O相关周围神经损害的临床与电生理特点分析

Analysis of clinicaland electrophysiologicalfeaturesin patients withnitrous oxide-induced neuropathy

目的 分析一氧化二氮所致周围神经损害患者的临床及神经传导特点。方法 对2019年9月至2022年6月中国科学技术大学附属第一医院诊治的7例N2O相关周围神经损害患者的临床特点进行总结,结合患者运动和感觉神经传导检查结果进行分析。结果 本组患者均以感觉或运动功能障碍症状起病,四肢麻木无力3例(3/7),双下肢麻木无力4例(4/7)。下肢的运动神经传导较上肢更容易受累且程度更重:下肢运动神经传导异常率大于上肢[100.0%(28/28)与17.9%(5/28),P<0.001],下肢CAMP未引出的比例大于上肢[42.9%(12/28)与0.0%(0/28),P<0.001];运动神经传导较感觉神经传导损害更严重:运动波幅未引出比例大于感觉[21.4%(12/56)与4.0%(2/50),P<0.05];感觉神经传导速度减慢较波幅降低更普遍:感觉传导速度减慢比例大于波幅减低[48.0%(24/50)与20.0%(10/50),P<0.05]。结论 一氧化二氮中毒性周围神经病患者运动和感觉神经均受累。下肢重于上肢,运动较感觉更重。

Objective To analyse the features of clinicalandnerve conduction in patientswithnitrous oxide-induced neuropathy.Methods The clinicaIandelectrophysiological data of 7 patients with nitrous oxide-induced neuropathy in the First Affiliated Hospitalof Scienceand Technologyof Chinawere analyzed.Results All patients in this group had sensory or motor dysfunction symptoms, including 3 cases(3/7) with numbness and weakness of limbs and 4 cases(4/7) with numbness and weakness of lower limbs.Motor nerve conduction in lower limbs was more likely to be involved and the degree was more severe than that in upper limbs: the abnormal rate of motor nerve conduction in lower limbs was higherthan that in upper limbs [100%(28/28) vs 17.9%(5/28),P<0.001],and the proportion of CAMP not elicited in lower limbs was higher than that in upper limbs [42.9%(12/28) vs0.0%(0/28),P<0.05].Motor nerve conduction was more seriously damaged than sensory nerve conduction: the proportion of motor wave amplitude not elicited was greater than that of sensory [21.4%(12/56) vs 4.0%(2/50),P<0.05].The slowing down of sensory nerve conduction velocity was more common than the decrease of amplitude: the proportion of the slowing down of sensory conduction velocity was greater than the decrease of amplitude [48.0%(24/50) vs 20.0%(10/50),P<0.05].Conclusion In patients with nitrous oxide toxic peripheral neuropathy, motor and sensory nerves are involved.Lower limbs are heavier than upper limbs, and movement is heavier than sensation.