ALS伴延髓麻痹24例瞬目反射检测结果分析

Study of application and clinical importance of blink reflex detection in the 24 ALS patients with bulbar palsy

目的 应用神经电生理检测瞬目反射研究肌萎缩侧索硬化脑干损害情况.方法 临床诊断ALS患者24例,均伴有延髓麻痹表现;健康对照组24例.瞬目反射检测在室温22~28℃时进行.记录电极采用表面皮肤电极,两个记录电极分别置于下眼轮匝肌外侧,参考电极置于颞部.刺激电极用手柄式电极,正负极间距2.5 cm,频率为1 Hz,电流为11~13 mA.分析记录:滤波带通2~10 kHz,分析时间100 ms.分别刺激左右两侧后记录两侧R1、R2、R2'.记录波形以清晰稳定为准,取连续五次的平均波潜伏期和波的峰值为波幅进行统计.组间样本t检验.结果 检测运动神经68条,末端潜伏期(DML)异常26条,占38.2%,运动波幅(dCMAPA)异常22条,占32.3%;检查F波44条,传导速度异常12条,占27.3%;F波出现率异常21条,占47.7%.常规EMG共检查肌肉110块.研究组BR检测48例次,R2潜伏期延长40例,异常率83.3%;R2'潜伏期延长40例,异常率83.3%;R2波幅降低1例,异常率2.1%;R2'波幅降低4例,异常率8.3%.结论 BR检测判断脑干损害的是一项方便、无创的电生理检测项目,可判断ALS患者伴有延髓性麻痹时的脑干损害.

Objective To investigate brainstem injury of ALS patients by using blink reflex detection.Methods The 24 cases of ALS patients with bulbar palsy and 24 healthy control were included in this study.Blink reflex test was performed at 22-28 ℃.Two surface skin electrodes used as recording electrode were placed on the outside lateral of inferior orbicularis oculi muscle.Handle type electrode with 2.5 cm of space between electrode poles,1 Hz of frequency,11-13 m A of current was used as stimulating electrode.Equal intensity stimulation produced by either pole.Analysis of recording:filter bandpass 2-10 k Hz,100 ms analysis time.Both sides were stimulated separately with same intensity.Latency and amplitude of R_1,R_2,R_2' of both sides were recorded.The average latency and amplitude calculated from five consecutive clear and stabled waves were recorded.Statistical method:Two sample t test.Results The 26 nerves with abnormal end latency(DML) and The 22 with abnormal movement amplitude(d CMAPA) in 68 motor nerves from 24 cases were found,with 38.2and 32.3 in percentage respectively.F wave checking shown 27.3% of abnormal F wave velocity(12 in 44nerves),and 47.7% of F wave abnormal rate(21 in 44).Routine EMG examination was performed on 110 blocks of muscles.BR detection of both sides was done in 24 patients.It turned out R_2 latency was prolonged in 40 cases,R_2' latency was prolonged in 40 cases,R_2 amplitude was decreased in 1 case,R_2' amplitude was reduced in4 cases,with 83.3%,83.3%,2.1% and 8.3% of abnormal rate respectively.Conclusion BR detection is a convenient,noninvasive electrophysiological detection method used to disclose injury in brainstem and is really useful for ALS patients with bulbar paralysis.