【摘要】： 前言 認(rèn)知過程是一個復(fù)雜的高級神經(jīng)心理活動,涉及感知覺、注意、記憶、思維等。在法醫(yī)學(xué)鑒定中,傳統(tǒng)的CT、MRI只能提供有限的形態(tài)學(xué)信息,而各種心理學(xué)量表測定容易受到主觀因素和受教育程度的影響。因此,研究腦損傷后認(rèn)知功能障礙的客觀評定方法具有重要意義。P300電位即受試者辨認(rèn)OB刺激序列中低概率的“靶刺激”時,在頭皮記錄到潛伏期約為300ms的最大晚期正性波,是ERP中應(yīng)用最廣、與認(rèn)知功能關(guān)系最為密切的成分。腦內(nèi)血腫、腦挫裂傷患者P300潛伏期延長、波幅下降。腦損傷后精神障礙的患者也有類似的結(jié)果。但不同部位腦損傷與P300電位的關(guān)系研究較少,且各種高級心理活動與P300的關(guān)系尚不明確。 本研究通過對正常人和腦損傷患者“主動”、“被動”聽覺P300測試,研究P300波形特點及其影響因素,并分析不同部位、不同程度腦損傷患者P300潛伏期、波幅與正常人的差異及影響因素,進(jìn)而為P300在評價腦損傷患者認(rèn)知功能障礙程度方面尋找客觀依據(jù)。 試驗對象與方法 受試對象:正常人受試組20人,均為中國醫(yī)科大學(xué)在校學(xué)生,各頻率的純音氣導(dǎo)聽閾均＜25dBHL。腦挫裂傷患者組30人,各頻率的純音氣導(dǎo)聽閾均＜25dBHL。所有患者均有明確的顱腦外傷史,腦挫裂傷的診斷由頭CT及MRI片證實,檢查時間距傷后6～12個月。 試驗方法:檢查在隔音室內(nèi)進(jìn)行,采用國際標(biāo)準(zhǔn)規(guī)定的上升法進(jìn)行純音測聽。采用NDI200—P+型多功能電生理記錄儀做為描記系統(tǒng),刺激信號為平臺期25ms的短純音,靶刺激頻率2000Hz,出現(xiàn)概率20%,非靶刺激頻率500Hz,出現(xiàn)概率80%,聲音強度均為72dBHL。帶通濾波設(shè)定為1～30Hz,刺激間隔1.1次/S,掃描時間為75ms,疊加50次。記錄電極置于Cz點、Pz點,參考電極位于耳垂,前額正中發(fā)際下1cm處置接地電極。電極阻抗＜5kΩ,極間電阻相差＜3kΩ。 試驗結(jié)果 1、正常人及腦損傷患者靶刺激均可誘發(fā)出兩個正相波及兩個負(fù)向波,潛伏期在70～500ms之間,分別為N100、P200、N200和P300。 2、“默計數(shù)”和“踩踏板”任務(wù)狀態(tài)下N200、P300波潛伏期較“被動”狀態(tài)下短,波幅高。 3、Cz點、Pz點P300各波潛伏期均無顯著性差異(P＞0.05)。N100、P200波幅Cz點高于Pz點(P＜0.05),N200、P300波幅Pz點略高于Cz點。 4、腦損傷患者N200、P300波潛伏期較正常人延長、波幅降低。彌漫腦挫裂傷患者N200、P300波潛伏期與其余組間具有統(tǒng)計學(xué)差異(P＜0.05)。 5、P300潛伏期在401ms以上的患者N200、P300波幅與300～350ms患者組間具有顯著性差異(P＜0.01),注意障礙患者P300波潛伏期改變最明顯。 結(jié)論 1、任務(wù)類型主要影響N200、P300波幅�！氨粍印盤300反應(yīng)中N200、P300潛伏期可作為衡量受試者認(rèn)知功能狀態(tài)的穩(wěn)定指標(biāo)。 2、腦挫裂傷患者N200、P300波潛伏期延長、波幅下降,“被動”P300潛伏期可作為認(rèn)知功能下降的客觀敏感指標(biāo),彌漫性腦損傷患者P300波潛伏期延長最明顯。 3、P300潛伏期是反映注意力、記憶及簡單計算力等認(rèn)知功能的綜合性指標(biāo),其中,注意力與P300潛伏期聯(lián)系最為密切。 4、在法醫(yī)學(xué)鑒定中,“被動”P300波潛伏期是反映腦挫裂傷患者認(rèn)知功能的客觀指標(biāo),可作為一種客觀檢測手段應(yīng)用于主觀不配合及無法合作。
[Abstract]:foreword The cognitive process is a complex high-level neuropsychological activity, involving perception, attention, memory, thinking, In the forensic appraisal, the traditional CT and MRI can only provide limited morphological information, and the measurement of various psychological scales is easily subject to the subjective factors and the degree of education. Therefore, it is important to study the objective evaluation method of cognitive impairment after brain injury Significance. When the P300 potential is the "target stimulation" in which the subject recognizes the low probability in the OB stimulation sequence, the maximum late positive wave with a latent period of about 300 ms is recorded on the scalp, which is the most widely used in the ERP and is the most closely related to the cognitive function. Components. Intracerebral hematomas, prolonged latency of P300 in brain contusion and laceration, amplitude The number of patients with mental disorder after brain injury is similar. Results: The relationship between brain injury and P300 potential of different parts is less, and the relationship between various high-level psychological activities and P300 is not enough. In this study, the "initiative" and "passive" auditory P300 of normal and brain injury patients were tested to study the characteristics of P300 and its influencing factors, and to analyze the difference of P300 latency and amplitude of P300 in different parts and different degree of brain injury. And to find out the degree of cognitive impairment of the P300 in the evaluation of brain injury. The objective is to be found. Test object and method:20 people in the test group of the normal person, all the students of the Chinese Medical University, the pure tone of each frequency The hearing threshold is less than 25 dBHL.30 of the patients with brain contusion and laceration and the pure tone of each frequency The hearing threshold was less than 25 dBHL. All patients had a clear history of head trauma, and the diagnosis of brain contusion and laceration was confirmed by head CT and MRI. 6-12 months after the time span injury. Test method: check in the sound insulation room and use the international The standard standard is used for pure tone audiometry. The NDI200 + P + type multifunctional electrophysiology recorder is used as the plethysmographic system. The stimulation signal is a short pure tone of 25 ms in the platform period. The target stimulation frequency is 2000 Hz, the occurrence probability is 20%, the non-target stimulation frequency is 500 Hz, and the occurrence probability 80 The sound intensity is 72 dBHL. The band-pass filtering is set to 1-30 Hz, and the stimulation interval is 1.1 times/ S. The tracing time is 75 ms and the superposition is 50 times. The recording electrode is placed at the Cz point and the Pz point, and the reference electrode is located in the earlobe and the forehead. The ground electrode is disposed 1 cm below the median hairline. The electrode impedance is less than 5k惟, The difference of the inter-electrode resistance is less than 3 k惟. The results of the test show that both normal and brain injury patients can induce two negative waves with a latent period of between 70 and 500 ms, and the latency is between 70 and 500 ms. N200, P300 wave latency

for N100, P200, N200, and P300.2, "Palmer's count", and "step-on board" tasks "passive" state short, high amplitude.3, Cz point, P There was no significant difference in the latency of P300 in the z-point (P> 0.05). The amplitude Cz of the P200 in the N100 and P200 was higher than that of the Pz (P <0.05). 0.05), the amplitude Pz of the N200 and P300 is slightly higher than the Cz point.4, The latency of N200 and P300 wave in brain injury patients was prolonged and the amplitude was decreased. The patients with diffuse brain contusion and laceration were N200. The latency of P300 wave and the remaining groups had statistical difference (P <0.05). writing Difference (P <0.01), P300 wave in patients with attention disorder Conclusion 1. The type of task mainly affects the amplitude of N200 and P300. The latency of N200 and P300 in the P300 reaction can be used as a stable indicator to measure the state of the cognitive function of the subject. The latency of N200 and P300 waves in the brain contusion and laceration is prolonged, the amplitude is decreased, and the "passive" P300 The latent period of P300 wave in the patients with diffuse brain injury is the most obvious, and the latency of P300 in patients with diffuse brain injury is the most obvious. The comprehensive index of cognitive function, such as attention, memory, and simple calculation force, is most closely related to the latency of P300. In the forensic appraisal, the "passive" P300
【學(xué)位授予單位】：中國醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R741;D919

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 嚴(yán)娜;視聽誘發(fā)腦電特征研究[D];山西大學(xué);2012年

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本文編號：2451008