脑卒中肩手综合征患者感觉障碍的定量分析(英文)

Quantitative sensory study on post-stroke shoulder-hand syndrome

背景:脑卒中偏瘫后肩手综合征(shoulder-handsyndrome,SHS)患者感觉减退已被证实,而感觉障碍的评估多用问卷式调查或仅为粗略临床检查来完成,难以精确评估。目的:运用定量感觉检查技术(quantitativesensorytesting,QST)检查脑卒中后肩手综合征观察组和脑卒中对照组各15例患者的温度觉及振动觉,并进行定量分析,以了解小纤维神经功能状态及其与肩手综合征的关系。设计:病例对照研究(case-controlstudy)。地点和对象:研究地点为中南大学湘雅三医院,对象涉及2000-06/2001-04湘雅三医院门诊及住院脑卒中后瘫痪病例。方法:用界限法分别检查观察组与对照组偏瘫侧上肢大鱼际掌侧温度觉阈值与拇指掌侧振动觉阈值。检查温度觉时,使用一个小的与检测区皮肤接触的热电极探头,探头温度以1℃/s速度递增(热觉、热痛觉)或递减(冷觉、冷痛觉),直至受检者产生感觉的那一刻由受检者本人按下按钮停止刺激。得到一个温度觉阈值,探头温度恢复到预置温度准备下一次刺激。重复4次得到平均温度觉阈值。在检测振动觉时,振动器的刺激强度以0.1～12μm/s的速度递增,重复检测6次。主要观察指标:感觉障碍发生率,温度觉、痛觉及振动觉的数据。结果:SHS组中感觉障碍发生率为67%较对照组27%显著增高(P<0.05)。SHS组与对照组定量感觉比较,?

BACKGROUND:It is certain that patients with shoulder-hand syndrome(SHS) hav e a decline in sensation.However,questionnaire or clinical evaluation for sensor y disorder is not accurate. OBJECTIVE: To explore the thermal and vibration sensations of post-stroke patientsby quantitative sensory testing(QST) in an attempt to assess the relatio nship between small nerve fibre function and SHS. DESIGN:A case-controlled study. SETTING AND SUBJECTS:Thirty cases of post-stroke paralysis were selected fr om outpatients and inpatients in the Third Xiangya Hospital of Central South Uni versity from 2000-06 to 2001-04. METHODS:Limit method was carried out to examine thermal,pain and vibration se nsations of affected upper limbs of the matched control patients(control group,n =15) and the patients with post-stroke shoulder-hand syndrome(SHS group,n=15 ).Incidences of shoulder-hand syndrome in two groups were also compared. MAIN OUTCOME MEASURES:The incidence of sensory disorder,thermal,pain and vibr ation sensation. RESULTS:Incidence of sensations dysfunction in SHS group was 67% ,significan tly higher than that in control group( 27% , P< O.O5) .Lowered cold-thresh old( 26.73± 4.48 vs 29.89± 1.57, P< 0.05) and elevated warm-threshold( 2 6.73± 4.48 vs 29.89± 1.57, P< 0.05) were found in both SHS group and control group without significant difference between them.Difference among cold-evoke d pain,heat-evoked pain and vibration thresholds was found significantly(P< 0. 01).Differences between cold evoked pain threshold and cold threshold,as well as heat-evoked pain threshold and warm threshold were significant( P< 0.01) . CONCLUSION:Incidence of disordered sensation function in post-stroke paraly zed patients with SHS increases significantly,which mostly presents by reduced t hermal sensation and hyperalgesia.C and A? nerve fibre dysfunction may play an important role in the pathogenesis.