本文選題：視覺誘發(fā)電位 + 視野��； 參考：《中國醫(yī)科大學》2008年碩士論文

【摘要】： 目的 視覺(vision)主要包括光覺、色覺和形覺,它是人感受外界的重要功能之一。其中形覺包括視力和視野二個方面。由于被鑒定人特殊的心理作用,常�？浯蠡騻窝b視功能障礙,使主觀性較大的臨床視野檢查法難以應用于臨床法醫(yī)學鑒定中。因此,如何客觀的評定視野狀態(tài)是臨床法醫(yī)學重要的研究課題之一。 視覺誘發(fā)電位(Visual evoked potential,VEP)是通過對視網(wǎng)膜進行刺激,經(jīng)過視路傳送在枕葉視皮層所誘發(fā)的電活動。反映了從視網(wǎng)膜神經(jīng)節(jié)細胞到視皮層的功能狀態(tài)。VEP分為閃光視覺誘發(fā)電位和圖像視覺誘發(fā)電位(Patten Visualevoked potential P—VEP),以P—VEP應用最為廣泛。P—VEP主要由負相波N_(75)(negative response 75)、正相波P_(100)(positive response 100)和負相波N_(145)(negativeresponse 145)三相復合波組成。其中P_(100)在所有健康人各個空間頻率的刺激中均能記錄到,正常變異小,穩(wěn)定可靠,故本試驗主要以P_(100)為觀察值。P—VEP是臨床醫(yī)學和法醫(yī)學鑒定中對視功能客觀評定的重要方法,以往研究認為不同刺激野P—VEP存在差異。研究不同刺激野P—VEP的特征將具有重要的法醫(yī)學意義。 本研究采用多通道記錄電極,分別置于30名(60眼)正常視功能者O_z、O_1、T_5、T_3、O_2、T_6、T_4、Pz、Oz、Iz點及自設點X。對不同刺激野進行刺激以誘發(fā)P—VEP,研究各刺激野P—VEP在Oz點P_(100)的正常潛伏期、波幅、波形特征及其相互之間的關(guān)系以及P—VEP在枕顳部不同部位電場分布特點,以期為探索視野功能的客觀評定方法提供基礎依據(jù)。 對象與方法 主觀檢查配合的受試者30名(60眼),男性和女性各15名,年齡范圍21—26歲,平均年齡23歲,均為中國醫(yī)科大學在校學生。篩選標準:矯正視力均≥1.0,主觀視野檢查均在正常范圍內(nèi)(手動視野計檢查法)。 試驗方法:采用上海海神(NDI-200P+)多功能電生理記錄儀,刺激器視屏大小為17′,選用視角30′及1°的翻轉(zhuǎn)黑白棋盤格作為刺激信號。刺激頻率3Hz,對比度與亮度調(diào)至顯示器80%固定。帶通濾波設定為1～100Hz,掃描時間為300ms,疊加次數(shù)為100次。 采用四通道記錄法對多個記錄點分別記錄不同刺激野P—VEP,電極為銀-氯化銀盤狀皮膚電極,按國際10-2腦電圖記錄系統(tǒng),記錄電極分別置于Oz點(枕骨粗隆點向上3.0cm)、O_1點(Oz點向左旁開2.0cm)、T_5點(Oz點向左旁開5.0cm)、T_3點(Oz點向左旁開10.0cm)、O_2點(Oz點向右旁開2.0cm)、T_6點(Oz點向右旁開5.0cm)、T_4點(Oz點向右旁開10.0cm)、Pz點(Oz點向上5.0cm)、Iz點(枕骨粗隆點)、自設點X點(Iz點向下2.0cm),接地電極置于手腕部,參考電極置于Fz點(鼻根上12.0cm)。各電極阻抗＜5kΩ,電極間電阻相差＜3kΩ。受試者眼在自然瞳孔狀態(tài)下,距刺激器視屏1.15米并與刺激器處于同一水平線,遮蓋單眼,囑被檢眼注視刺激器注視點,記錄Oz、O_1、T_5、T_3、O_2、T_6、T_4點(其中Oz、O_1、O_2為正中組電極)在下列刺激野P—VEP結(jié)果:中央全屏刺激野(16°刺激野)、左/右半刺激野(8°及16°刺激野)中央中心屏刺激野(中央8°刺激野)、左/右半中心刺激野(4°刺激野)和左/右旁中心刺激野(8°及16°視野中去除4°視野)。變換電極記錄點為Pz、Oz、Iz及自設點X后,記錄中央全屏刺激野、上全屏刺激野及下全屏刺激野P—VEP結(jié)果。采用四通道記錄法對多個記錄點分別記錄不同刺激野P—VEP,測試時間約40s,每次測試間隔2-3分鐘,讓被測眼休息,以消除視疲勞。 結(jié)果 1、正常人上全屏刺激野、中央全屏刺激野與下全屏刺激野的P—VEP結(jié)果: 給予上、下全屏刺激野及中央全屏刺激野刺激,各記錄點P_(100)潛伏期為:下刺激野＜全刺激野＜上刺激野;波幅為:上刺激野＜下刺激野＜全刺激野。 不同記錄點間各刺激野P_(100)潛伏期比較:X點＜Iz點＜Pz點＜Oz點;波幅:X點＜Iz點＜Pz點＜Oz點。 中央全屏刺激野及下全屏刺激野所誘發(fā)VEP波形較上全屏刺激野刺激誘發(fā)的波形規(guī)整、波幅大易分辨,且下部電極記錄到的上刺激野誘發(fā)VEP有15.83%出現(xiàn)位相倒轉(zhuǎn)。在Pz點可在各刺激野條件下記錄到P—VEP,雖波幅較Oz點低,特別是上刺激野條件下Pz點記錄到的波幅最低,但Pz點P—VEP波形光滑、干擾小。 2、正常人中央全屏刺激P_(100)波分布: 給予正常人在中央全屏刺激野刺激,雙側(cè)對應記錄點記錄到的P—VEP波形對稱一致,各記錄點P_(100)潛伏期及波幅與記錄點距Oz點距離呈負相關(guān)。即比較相同中央刺激野誘發(fā)P—VEP:中央部電極記錄到P—VEP波幅最大,潛伏期最長。隨著記錄點與Oz點距離的增加,所得P—VEP波幅逐漸降低,潛伏期亦逐漸縮短。 3、正常人左、右半刺激野P—VEP結(jié)果: 半視野刺激的VEP幅度較低,在頭頂呈明顯的不對稱的分布,刺激野同側(cè)的VEP波形較恒定,為N-P-N復合波。刺激野對側(cè)的VEP波形較復雜,變異大。本試驗主要表現(xiàn)為四種類型:①刺激野同側(cè)出現(xiàn)N-P-N波,對側(cè)無可辨認的VEP成份;②刺激野同側(cè)出現(xiàn)N-P-N波,對側(cè)有位相倒轉(zhuǎn)的P-N-P波;③刺激同側(cè)為N-P-N波,對側(cè)VEP呈部分相倒轉(zhuǎn)狀;④刺激野同側(cè)為N-P-N波,對側(cè)亦呈N-P-N復合波 在側(cè)半視野刺激時:刺激野同側(cè)電極均記錄到N-P-N復合波,中央部電極亦為N-P-N復合波。刺激野對側(cè)電極記錄到的P—VEP波形中,約7.1%無法辨認;約12.92%出現(xiàn)倒轉(zhuǎn)復合波或部分倒轉(zhuǎn)復合波;約79.98%出現(xiàn)N-P-N復合波。 在旁半視野刺激時:刺激野同側(cè)記錄點有11.94%記錄到無法辨認的復合波,88.06%為N-P-N復合波,中央部電極可與刺激野同側(cè)相同,亦可與刺激野對側(cè)相同。刺激野對側(cè)記錄點有14.58%記錄到N-P-N復合波,43.06%記錄到P-N-P復合波,42.36%記錄到無法辨認的P—VEP波形。 4、鼻、顳側(cè)刺激野VEP結(jié)果: 與顳側(cè)刺激野刺激產(chǎn)生的波形相比,中央刺激野刺激產(chǎn)生的VEP波形與鼻側(cè)刺激野刺激產(chǎn)生的波形更相似。 雙眼鼻側(cè)刺激野與顳側(cè)刺激野比較,P_(100)潛伏期具有統(tǒng)計學差異,鼻側(cè)刺激野較顳側(cè)刺激野P_(100)潛伏期延長3.9±1.2ms。雙眼間相同刺激野比較,P_(100)潛伏期無統(tǒng)計學意義。 5、中央全屏與中央中心屏刺激野VEP結(jié)果: 全屏16°刺激野與中央8°刺激野比較P_(100)潛伏期無統(tǒng)計學差異,全屏刺激野與中央刺激野比較P_(100)波幅顯著增高,具有統(tǒng)計學意義。 6、側(cè)半刺激野、側(cè)半中心刺激及側(cè)半旁中心刺激野VEP結(jié)果: P_(100)潛伏期:側(cè)半中心刺激野≈側(cè)半刺激野＜側(cè)半旁中心刺激野。P_(100)波幅:側(cè)半旁中心刺激野＜側(cè)半中心刺激野≈側(cè)半刺激野。 結(jié)論 1、正常人上刺激野、中央刺激野和下刺激野P—VEP潛伏期及波幅存在差異,Pz、Oz、Iz和自設點X在相同刺激條件下記錄的P—VEP存在差異。Iz和自設點X對記錄上刺激野誘發(fā)P—VEP較穩(wěn)定。 2、中央全屏誘發(fā)VEP波隨記錄點不同存在差異,水平及垂直方向隨著與Oz點距離增加,P100波幅逐漸減小。 3、不同半刺激野誘發(fā)VEP波在水平各記錄點記錄波存在差異。于刺激野同側(cè)記錄點可較穩(wěn)定記錄到VEP波,于對側(cè)可記錄到特異的VEP波。 4、各種半刺激野中,包含中心刺激的P—VEP誘發(fā)率高。在不含中心刺激的旁中心刺激野P—VEP中,增加刺激野面積或適當增大刺激視角可提高P—VEP檢出率。
[Abstract]:objective
Vision mainly includes light, color and shape perception. It is one of the most important functions of people to feel the outside world. It includes two aspects of vision and vision. Due to the special psychological function of the identified person, it is often exaggerated or disguised as the visual dysfunction, so the subjective clinical field examination method is difficult to apply to the clinical forensic identification. Therefore, how to evaluate the state of vision objectively is one of the important research topics in clinical forensic science.
Visual evoked potential (VEP) is an electrical activity induced by the optic pathway through the retina, which reflects the functional state of the retinal ganglion cells to the visual cortex, which is divided into the flash visual evoked potential and the image visual evoked potential (Patten Visualevoked potential P V). EP), with P - VEP, the most widely used.P - VEP is composed mainly of negative phase wave N_ (75) (negative response 75), positive phase wave P_ (100) (positive response 100) and negative phase wave N_ (145) (145) (145) three phase composite waves. P_ (100) as an observation value of.P - VEP is an important method for objective evaluation of visual function in clinical and forensic forensic studies. Previous studies suggest that there is a difference between P and VEP in different irritation fields. The study of the characteristics of P VEP in different irritation fields will have important forensic significance.
In this study, a multichannel recording electrode was used in 30 (60 eyes) normal visual functions, O_z, O_1, T_5, T_3, O_2, T_6, T_4, Pz, Oz, Iz points, and self point X. to stimulate the different stimulus fields to induce the P to be induced, and to study the positive latency, amplitude, waveform characteristics and the relationship between the stimuli field (100). The distribution characteristics of electric field in different parts of occipital temporal region, in order to provide a basis for exploring objective assessment methods of visual field function.
Object and method
30 subjects (60 eyes) with subjective examination, 15 men and women each, age range from 21 to 26 years old and average age 23 years old, were all students at China Medical University. The screening criteria: corrected visual acuity was equal to 1, and the subjective field of vision was within the normal range (manual perimeter examination).
The test method: the Shanghai sea god (NDI-200P+) multi-function electrophysiological recorder was used. The size of the stimulator screen was 17 ', the angle 30' and 1 degree turned black and white checkerboard was used as the stimulus signal. The stimulation frequency was 3Hz, the contrast and brightness were adjusted to the display 80%. The bandpass filter was set to 1 to 100Hz, the scanning time was 300ms, and the number of superposition times was 100 times.
The four channel recording method was used to record the different stimulation fields P - VEP, and the electrode was silver chloride silver disk like skin electrode. According to the international 10-2 electroencephalogram recording system, the recording electrodes were placed at Oz point (occipital roughing point up 3.0cm), O_1 point (Oz point to left side 2.0cm), T_5 point (Oz point to left 5.0cm), T_3 point (10 Oz points to left side open to left side 10). .0cm), O_2 point (Oz point to right side 2.0cm), T_6 point (Oz point to right side open 5.0cm), T_4 point (Oz point to right side 10.0cm), Pz point (Oz point upward), self point point (point downward), grounding electrode placed in the wrist, reference electrode placed on the nose root (nose root). In the natural pupil of the subjects, the subjects were 1.15 meters from the stimulator screen and placed on the same horizontal line with the stimulator, covering the monocular and being asked to look at the fixator of the stimulator, recording Oz, O_1, T_5, T_3, O_2, T_6, T_4 points (Oz, O_1, O_2 as the median electrode) in the lower column stimulated wild P VEP results: the central full screen stimulation field (16 degree stimulation field), left / right The central central screen stimulation field in the semi irritant field (8 and 16 degrees irritation field), the central 8 degree stimulation field, the left / right semi central stimulation field (4 degree stimulation field) and the left / right paraplastic central stimulation field (8 degrees and 16 degrees in the field of vision). The recording points of the transform electrode are Pz, Oz, Iz and self set X, and the central full screen stimulation field is recorded, and the full screen stimulus field and the lower full screen stimulation field P are recorded. VEP results. The four channel recording method was used to record the different stimulation fields P VEP respectively. The test time was about 40s and the interval of each test was 2-3 minutes, so that the eye was rest to eliminate visual fatigue.
Result
1, the full screen stimulation field on the normal subjects, the P VEP results of the central full screen stimulation field and the whole screen stimulus field:
At the top of the full screen stimulation field and the central full screen stimulation, the P_ (100) incubation period of each record point was: the lower stimulation field was "all irritation field", and the amplitude was: the upper stimulation field was less than the whole irritation field.
The latency of P_ (100) between different recording points was compared: X point < Iz point < Pz point < Oz point; amplitude: X point < Iz point < Pz point < Oz point.
The VEP waveforms induced by the central full screen stimulation field and the lower full screen stimulation field are more sensitive to the waveform regulation induced by the full screen stimulation field stimulation. The amplitude of the wave amplitude is easily resolved, and the VEP in the upper stimulus field recorded by the lower electrode has 15.83% phase inversion. At the Pz point, the P VEP can be recorded in the stimulus field, although the amplitude is lower than that of the Oz point, especially the upper stimulus field. Under the condition, the Pz points recorded the lowest amplitude, but the Pz point P - VEP waveform is smooth and the interference is small.
2, the P_ (100) wave distribution was stimulated by the central full screen of normal people:
The normal people were stimulated by the central full screen stimulation field, and the P VEP waveform recorded by the bilateral corresponding record points was the same. The P_ (100) latency and amplitude of each recording point were negatively correlated with the distance from the Oz point. That is, the same central stimulation field induced the P VEP: central electrode to record the maximum amplitude of P VEP and the longest incubation period. With the record, the recording point was the longest. The increase of the distance from the Oz point to the P point decreases the amplitude of the VEP - wave.
3, left and right half - stimulation field P - VEP results in normal people:
The VEP amplitude of the half field stimulation was lower, the distribution of the VEP waveform in the irritation field was more constant and the N-P-N complex wave was more constant. The VEP wave in the opposite side of the stimulation field was more complex and varied. The main manifestations of this experiment were four types: (1) the N-P-N wave in the irritation field of the wild, the non identifiable VEP component in the opposite side; The present N-P-N wave has a phase inversion of P-N-P wave on the opposite side; (3) the stimulation of the same side is the N-P-N wave and the opposite side VEP is partially reversed; (4) the stimulation of the same side is N-P-N wave, and the opposite side is also a N-P-N complex wave.
In the side half field stimulation, the stimulated field ipsilateral electrode recorded the N-P-N complex wave and the central electrode was also N-P-N complex wave. About 7.1% could not be identified in the P VEP waveform recorded by the field to side electrode; about 12.92% appeared reversed complex wave or partial inversion complex wave, and about 79.98% appeared N-P-N complex wave.
In the side half field of vision stimulation, the stimulation field is 11.94% to the unrecognizable complex wave, 88.06% is the N-P-N complex wave, the central electrode can be the same as the irritating field, and the same to the irritating field. The stimulation field is 14.58% to the N-P-N complex wave, 43.06% to the P-N-P complex wave, and 42.36% to the impossible. Identified P - VEP waveform.
4, nasal, and temporal stimulation of the wild VEP results:
Compared with the waveform generated by temporal stimulation field stimulation, the VEP waveform generated by the central stimulation field is more similar to the waveform generated by the stimulation on the nasal side.
Compared with the temporal irritation field in the binocular lateral irritation field, the latent period of P_ (100) was statistically different, and the P_ (100) latency of the nasal irritation field was longer than that of the temporal irritation field (100), which was 3.9 + 1.2ms. between the two eyes, and the latency of P_ (100) was not statistically significant.
5, central full screen and central central screen stimulation field VEP results:
There was no statistical difference in the latent period of P_ (100) in the full screen 16 degree stimulation field and the central 8 degree stimulation field. The P_ (100) amplitude of the full screen stimulation field and the central stimulation field increased significantly, with statistical significance.
6, the side semi stimulation field, lateral semi central stimulation and lateral para center stimulation field VEP results:
The latent period of P_ (100): the lateral semi central stimulation field semi irritant wild.P_ (100) wave amplitude in the lateral paralateral central stimulation field: the side half central stimulation of the wild semi central irritation field.
conclusion
1, there are differences in the latent period and amplitude of P - VEP in the normal human stimulation field, the central stimulation field and the lower stimulation field. The P - VEP, the Pz, Oz, Iz and self - set X, recorded in the same stimulus conditions, the.Iz and the self - set X are stable to the P VEP.
2, the central full screen induced VEP wave is different from the recording point. The P100 amplitude decreases with the increase of Oz distance in horizontal and vertical directions.
3, there is a difference in the recording of the VEP wave at the level of the horizontal recording point induced by different semi irritant fields. The VEP wave can be recorded steadily at the ipsilateral recording point of the irritant field, and the specific VEP wave can be recorded on the contralateral side.
4, in various semi irritant fields, the rate of P - VEP, which contains central stimulation, is high. In the paracenter P - VEP without central stimulation, the increase of the area of the stimulation field or the appropriate increase of the stimulus angle can increase the detection rate of P VEP.

【學位授予單位】：中國醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2008
【分類號】：D919;R77

【引證文獻】

相關(guān)碩士學位論文 前1條

1 張元鐘;中醫(yī)辯證治療視神經(jīng)萎縮的臨床研究[D];南京中醫(yī)藥大學;2011年

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