本文選題：腦癱 + 運(yùn)動(dòng)功能��； 參考：《安徽醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的探討表面肌電（sEMG）運(yùn)動(dòng)單位動(dòng)作電位（MUAP）的平均發(fā)放間隔（IPI）在痙攣型腦癱兒童早期診斷及療效評(píng)估中可行性。 方法1.選取符合納入和排除標(biāo)準(zhǔn)的64例9～160個(gè)月痙攣型腦癱患兒為實(shí)驗(yàn)組，采用中文版粗大運(yùn)動(dòng)功能測(cè)試(GMFM88項(xiàng))和分級(jí)系統(tǒng)(GMFCS)、臨床痙攣指數(shù)（CSI）等進(jìn)行粗大運(yùn)動(dòng)功能和痙攣程度的評(píng)定，同時(shí)利用表面肌電技術(shù)結(jié)合力學(xué)加速度計(jì)，應(yīng)用課題組前期建立的基于經(jīng)驗(yàn)?zāi)B(tài)分解(EMD)的三級(jí)濾波器技術(shù)和平滑非線性能量算子算法（SNEO算法），計(jì)算腦癱患兒運(yùn)動(dòng)單位動(dòng)作電位（MUAP）的平均發(fā)放間隔(IPI)，結(jié)合性別、月齡、GMFM-88項(xiàng)總評(píng)分、GMFCS分級(jí)結(jié)果及痙攣程度同對(duì)應(yīng)的IPI進(jìn)行統(tǒng)計(jì)學(xué)相關(guān)分析處理，探討臨床常用評(píng)估方法與表面肌電MUAP的IPI的相關(guān)性。 2.通過(guò)上述相關(guān)分析，探討影響運(yùn)動(dòng)單位動(dòng)作電位的IPI相關(guān)性因素，采用回歸統(tǒng)計(jì)處理，建立適合的回歸模型，為IPI參數(shù)量化作為評(píng)估指標(biāo)奠定基礎(chǔ)性的研究。 3.參照實(shí)驗(yàn)組性別、月齡為基線選取正常兒童64例作為對(duì)照組，應(yīng)用表面肌電技術(shù)，測(cè)定其運(yùn)動(dòng)單位動(dòng)作電位（MUAP）的平均發(fā)放間隔(IPI)，對(duì)兩組數(shù)據(jù)的IPI行t檢驗(yàn)對(duì)比分析。 4.選取圍產(chǎn)期腦損傷兒20例作為預(yù)測(cè)實(shí)驗(yàn)組，20名正常新生兒為預(yù)測(cè)對(duì)照組，分別在足月齡4周、8周、16周行全身運(yùn)動(dòng)的表面肌電技術(shù)評(píng)估，實(shí)驗(yàn)預(yù)測(cè)組校正年齡3月內(nèi)行頭顱影像學(xué)檢查評(píng)估，并隨訪至12月齡，總結(jié)明確診斷腦癱的人數(shù)，計(jì)算兩組患兒三次測(cè)定的運(yùn)動(dòng)單位動(dòng)作電位的IPI平均值；分析腦癱患兒全身運(yùn)動(dòng)的表面肌電特性，，探討IPI在腦癱早期診斷中的應(yīng)用價(jià)值。 結(jié)果1.表面肌電信號(hào)的IPI與GMFCS分級(jí)、痙攣亞型、痙攣指數(shù)及痙攣程度呈正相關(guān)的關(guān)系（rs分別為0.903、0.527、0.663、0.499，P0.001）；與GMFM-88項(xiàng)總評(píng)分呈負(fù)相關(guān)的關(guān)系（rs為-0.744，P0.001），均具有統(tǒng)計(jì)學(xué)意義；與月齡及性別無(wú)明顯相關(guān)性（P0.05）。 2.腦癱患兒表面肌電IPI與痙攣指數(shù)及運(yùn)動(dòng)功能評(píng)分的逐步回歸方程為=6.019+1.011X1-0.66X2（、X1、X2分別代表IPI、痙攣指數(shù)、GMFM88項(xiàng)總評(píng)分），R2=0.642。 3.實(shí)驗(yàn)組與對(duì)照組兒童表面肌電MUAP的IPI差異具有統(tǒng)計(jì)學(xué)意義（P0.05）。 4.圍產(chǎn)期腦損傷兒20例中，16例發(fā)展為腦癱；預(yù)測(cè)實(shí)驗(yàn)組與對(duì)照組兒童表面肌電MUAP的IPI差異無(wú)明顯統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論1.基于經(jīng)驗(yàn)?zāi)B(tài)分解(EMD)的三級(jí)濾波器技術(shù)和SNEO算法,計(jì)算出的表面肌電信號(hào)MUAP的IPI與腦癱兒童的痙攣狀態(tài)、運(yùn)動(dòng)功能密切相關(guān)，可以作為痙攣型腦癱患兒的客觀性、綜合性的量化療效評(píng)估指標(biāo)。 2.表面肌電技術(shù)在圍產(chǎn)期腦損傷兒全身運(yùn)動(dòng)評(píng)估中具有一定的預(yù)測(cè)價(jià)值，但其運(yùn)動(dòng)單位動(dòng)作電位的IPI尚不能成為腦癱早期診斷的有效評(píng)估指標(biāo)。
[Abstract]:Objective to investigate the feasibility of the mean release interval IPI (IPI) of motor unit action potential (MUAPP) in children with spastic cerebral palsy. Method 1. A total of 64 children with spastic cerebral palsy from 9 to 160 months were selected as experimental group. The Chinese version of GMFM88 test was used to evaluate the gross motor function and the clinical spasticity index (CSI) of GMFCSA and the clinical spasticity index (CSI) were used to evaluate the motor function and the degree of spasticity in 64 children with spastic cerebral palsy at 9 ~ 160 months in accordance with the criteria of inclusion and exclusion. At the same time, using surface electromyography technology combined with mechanical accelerometer, The three-level filter technique based on empirical mode decomposition (EMD) and the smoothing nonlinear energy operator algorithm (Sneo) were used to calculate the mean release interval of motor unit action potential (MUAPP) in children with cerebral palsy. The results of GMFM-88 total score and the degree of spasticity were statistically correlated with the corresponding IPI, and the correlation between the commonly used clinical evaluation methods and the IPI of surface electromyography (MUAP) was discussed. 2. Through the above correlation analysis, the IPI correlation factors affecting the motor unit action potential are discussed, and the regression statistical treatment is adopted to establish a suitable regression model, which lays a foundation for the study of quantification of IPI parameters as an evaluation index. 3. According to the sex of the experimental group, 64 normal children were selected as the control group. The mean release interval of motor unit action potential (MUAPP) was measured by surface electromyography. The IPI data of the two groups were analyzed by t test. 4. Twenty neonates with perinatal brain injury were selected as the predictive control group, 20 normal newborns were used as the predictive control group, and the surface electromyography (EMG) technique of the whole body movement was evaluated at 4 weeks, 8 weeks and 16 weeks, respectively, at the age of 4 months, 8 weeks and 16 weeks, respectively. The experimental prediction group was evaluated with cranial imaging within 3 months of age and followed up to 12 months of age. The number of children diagnosed with cerebral palsy was summarized and the IPI mean value of motor unit action potential measured three times in both groups was calculated. To investigate the value of IPI in the early diagnosis of cerebral palsy, the surface electromyography of children with cerebral palsy was analyzed. Result 1. There was a positive correlation between IPI and GMFCS grade, spasm subtype, spasticity index and degree of spasticity. Rs was 0.903 / 0. 527 / 0. 663rs / 0. 499p 0.001and negatively correlated with total GMFM-88 score (P = -0. 744 / P0. 001), respectively, and had no significant correlation with age and sex (P 0. 05). 2. The stepwise regression equation of surface electromyography (IPI), spasticity index and motor function score in children with cerebral palsy was 6.019 1.011X1-0.66X2 + X1X2, respectively. The total score of spasticity index (GMFM88) was 0.642. 3. There was significant difference in IPI of MUAP between the experimental group and the control group (P 0.05). 4. Among the 20 cases of perinatal brain injury, 16 cases developed cerebral palsy, and there was no significant difference in IPI of surface myoelectric MUAP between the experimental group and the control group (P 0.05). Conclusion 1. Based on empirical mode decomposition (EMD) three-level filter technique and SNEO algorithm, the calculated IPI of surface electromyography (MUAP) is closely related to spasticity and motor function of children with cerebral palsy, and can be regarded as objectivity of children with spastic cerebral palsy. Comprehensive quantitative evaluation index of curative effect. 2. Surface myoelectric technique has certain predictive value in the evaluation of perinatal brain injury, but the IPI of motor unit action potential can not be an effective index for the early diagnosis of cerebral palsy.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R742.3

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