本文選題：接觸性熱痛誘發(fā)電位 + 丘腦梗死��； 參考：《吉林大學》2017年碩士論文

【摘要】：目的:丘腦梗死是神經(jīng)內(nèi)科常見的疾病之一。盡管頭部MRI等影像學檢查能精確地作出解剖學相關定位診斷,但無法對患者脊髓丘腦束的功能情況進行定量分析。接觸性熱痛誘發(fā)電位(contact heat evoked potentials,CHEPs)利用在一定范圍內(nèi)迅速升高溫度的刺激器刺激皮膚的感覺神經(jīng)末梢,能夠選擇性識別、刺激薄髓鞘Aδ纖維和無髓的C纖維的傷害性感覺傳遞功能,進而檢測痛覺傳導通路的變化特點,是一種較新的用于檢查痛覺障礙及脊髓丘腦束功能的非侵入性客觀方法。本文應用CHEPs技術(shù)研究丘腦梗死患者痛覺傳導通路中脊髓丘腦束功能的變化特點,探討CHEPs檢測技術(shù)及Aδ纖維傳導速度在丘腦梗死中的應用價值,并為丘腦梗死的電生理診斷提供參考依據(jù)。方法:按照下文納入標準及排除標準共收集2014年1月至2016年12月期間于吉林大學中日聯(lián)誼醫(yī)院就診的受試者55例,其中單純丘腦梗死患者24例,丘腦梗死合并糖尿病患者9例,糖尿病(diabetes mellitus,DM)患者12例,無糖尿病、丘腦梗死的正常對照組10例。應用接觸性熱痛誘發(fā)電位刺激器,以54.5℃的恒定刺激溫度,對患者上肢前臂掌側(cè)近端1/3處、頸部C7棘突,胸椎T12棘突,小腿等皮膚進行熱痛刺激,受試者經(jīng)熱痛刺激3-5s后,按照視覺模擬評分法(visual analogue scale,VAS),對刺激強度進行評級(1~10級)。CHEPs記錄位點位于Fz、Cz和Pz,記錄其CHEPs波形、潛伏期,并計算出Aδ纖維傳導速度。同時對入選患者進行SCV、MCV等測定,將其結(jié)果與CHEPs進行比較分析。結(jié)果:1、cheps波形能穩(wěn)定而可靠的引出。不同組間cheps異常率比較差異有統(tǒng)計學意義(p0.05)。不同組間cheps潛伏期比較差異有統(tǒng)計學意義:dm組、丘腦病變+dm組、丘腦梗死組位于前臂內(nèi)側(cè)、脛前外側(cè)的cheps潛伏期較正常對照組延長,差異有統(tǒng)計學意義(p0.05)。c7不同組間差異無統(tǒng)計學意義(p0.05)。2、cheps潛伏期與丘腦梗死的病灶大小、主觀感覺障礙的比較中,差異有統(tǒng)計學意義(p0.05);cheps潛伏期與丘腦梗死的側(cè)別比較,差異均無統(tǒng)計學意義(p0.05)。3、dm組、丘腦病變+dm組aδ纖維脊髓段傳導速度、外周段傳導速度較正常對照組減慢,差異有統(tǒng)計學意義(p0.05),丘腦梗死組與正常對照組的cheps脊髓段傳導速度、外周段傳導速度比較差異無統(tǒng)計學意義(p0.05)。4、dm組cheps異常率明顯大于mcv異常率,差異有統(tǒng)計學意義(p0.05)。不同組間mcv比較,差異具有統(tǒng)計學意義:dm組、丘腦病變+dm組與正常對照組正中神經(jīng)波幅、脛神經(jīng)傳導速度、脛神經(jīng)波幅降低/減慢,差異具有統(tǒng)計學意義(p0.05),丘腦梗死組與正常對照組比較差異無統(tǒng)計學意義(p0.05)。不同組間scv比較,差異具有統(tǒng)計學意義:dm組、丘腦病變+dm組與正常對照組正中神經(jīng)波幅、腓淺神經(jīng)傳導速度、腓淺神經(jīng)波幅降低/減慢,差異具有統(tǒng)計學意義(p0.05),丘腦梗死組與正常對照組比較差異無統(tǒng)計學意義(p0.05)。5、不同組間治療前vas評分,差異具有統(tǒng)計學意義:丘腦梗死組、丘腦病變+dm組、dm組在治療前vas較正常對照組降低,差異有統(tǒng)計學意義(p0.05)。不同組間治療后vas評分,差異無統(tǒng)計學意義(P0.05)。CHEPs波形正常的患者,其治療前后的VAS的變化較CHEPs波形異常的患者治療前后變化更顯著,差異具有統(tǒng)計學意義(P0.05)。結(jié)論:1、丘腦梗死患者存在痛覺傳導通路脊髓丘腦束功能受累,但未影響痛覺傳導通路的脊髓段、周圍段,僅影響了中樞段。2、定點(前臂內(nèi)側(cè)、脛前外側(cè))CHEPs測定有助于判斷脊髓丘腦束功能的損害。3、CHEPs對丘腦梗死患者的感覺障礙具有客觀指示作用,對于丘腦梗死與局部神經(jīng)病變的鑒別診斷及發(fā)現(xiàn)亞臨床病變有一定幫助。4、丘腦梗死患者的早期治療效果與CHEPs異常率有關,CHEP波形基本正常的患者痛覺傳導通路損傷較小,早期治療效果較好。
[Abstract]:Objective: thalamic infarction is one of the most common neurological diseases. Although the head MRI imaging can accurately make anatomic diagnosis, but is unable to function in patients of the spinothalamic tract were quantitatively analyzed. The contact heat evoked potential (contact heat evoked potentials, CHEPs) using the stimulator rapid temperature increase in a certain range in the stimulation of sensory nerve endings in the skin, can selectively recognize, transfer function of sensory stimulation thin myelinated and unmyelinated fiber A 8 C fiber damage, and to detect changes in the pain pathway characteristics, is a relatively new method for objective noninvasive pain disorders and spinothalamic tract function. The change characteristics of spinothalamic tract function using CHEPs Technology to study the thalamic infarction patients pain pathway in the study of CHEPs detection technology and A delta fiber conduction velocity in the high The application value of cerebral infarction, and to provide reference for electrophysiological diagnosis of thalamic infarction. Methods: according to the 55 subjects below the inclusion criteria and exclusion criteria were collected from January 2014 to December 2016 during the visit to Japan Union Hospital of Jilin University, including simple thalamic infarction in 24 patients with thalamic infarction patients with diabetes in 9 cases. Diabetes (diabetes mellitus, DM) in 12 cases, patients without diabetes, the normal control group of 10 cases of thalamic infarction. Application of the contact heat evoked potential stimulator, stimulating constant temperature to 54.5 DEG C, the upper limb in patients with volar forearm proximal 1/3, C7 cervical spinous process, thoracic spinous process of T12, calf skin heat pain stimulation, subjects with thermal pain after 3-5s stimulation, according to visual analogue scale (visual analogue scale, VAS), rating of stimulus intensity (1~10).CHEPs recording sites located in Fz, Cz and Pz, the CHEPs wave records The shape, incubation period, and calculate the A delta fiber conduction velocity. At the same time for SCV patients, MCV were measured, the results were compared with CHEPs. Results: 1, cheps waveform can be stable and reliable. Leads to the abnormal rate of cheps among different groups had significant difference (P0.05) was statistically significant. Cheps latency differences between different groups: DM group, +dm group of thalamic lesions, thalamic infarction group is located in the medial forearm, anterior lateral cheps latency compared with normal control group increased, the difference was statistically significant (P0.05) differences of.C7 among different groups was statistically significant (P0.05).2, cheps latency and thalamic infarction lesion size comparison, subjective sensory disturbance, the difference was statistically significant (P0.05); cheps latency and thalamic infarction side comparison showed no significant difference (P0.05).3, DM group, +dm group of thalamic lesions a delta fiber segment of the spinal cord conduction velocity of peripheral segment The conduction velocity slowed down compared to the normal control group, the difference was statistically significant (P0.05), cheps spinal cord conduction velocity of thalamic infarction group and normal control group, no significant difference between the conduction velocity of peripheral segment (P0.05).4, DM group, the abnormal rate of cheps was significantly higher than the rate of abnormal MCV, the difference was statistically significant (P0.05). Comparison of MCV between different groups, the difference was statistically significant: DM group, +dm thalamic lesion group and normal control group the median nerve amplitude of tibial nerve conduction velocity, tibial nerve amplitude decreased / slow, the difference was statistically significant (P0.05), thalamic infarction group and normal control group had no significant difference between SCV (P0.05). Among different groups, the difference was statistically significant: DM group, +dm thalamic lesion group and normal control group the median nerve amplitude, superficial peroneal nerve and superficial peroneal nerve conduction velocity, amplitude decreased / slow, the difference was statistically significant (P0.05), thalamus. The death group and normal control group had no significant difference (.5, P0.05) among different groups before treatment VAS score, the difference was statistically significant: thalamic infarction group, thalamic lesions in the +dm group, DM group before the treatment of vas is lower than normal control group, the difference was statistically significant (P0.05). Different groups after treatment, vas the score, the difference was not statistically significant (P0.05) in patients with normal.CHEPs waveform, changes before and after the treatment of VAS patients before and after treatment with CHEPs wave abnormal changes more significantly, the difference was statistically significant (P0.05). Conclusion: 1, thalamic infarction patients have pain pathway of spinothalamic tract dysfunction, but did not affect the spinal cord section, the pain pathway around, only affects the central segment of.2 point (the inner side of the forearm, anterior lateral) determination of CHEPs is helpful in judging the spinothalamic tract dysfunction.3 CHEPs sensory disturbance on the thalamus infarction with objective Indication, for differential diagnosis of thalamic infarction and the local nerve lesions and discover subclinical lesions have helped.4, the effect of early treatment with CHEPs in patients with thalamic infarction and abnormal rate of the CHEP waveforms in patients with normal pain pathway of minor injury and early treatment effect is good.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.33

【相似文獻】

相關期刊論文 前10條

1 王玉鳳,米景龍,劉紅軍;丘腦梗死后記憶與智能障礙的初步研究[J];臨床神經(jīng)病學雜志;2000年06期

2 王子英;以多食多飲為主要表現(xiàn)的丘腦梗死2例[J];中國煤炭工業(yè)醫(yī)學雜志;2000年10期

3 蒙向紅;;18例丘腦梗死不同的臨床特點[J];中國當代醫(yī)藥;2011年18期

4 黃月虹;耿昱;;丘腦梗死患者的臨床特點[J];心腦血管病防治;2013年05期

5 李春燕;丘腦梗死32例臨床分析[J];河南實用神經(jīng)疾病雜志;2000年04期

6 張紅宇,楊巧蓮,段建平;雙側(cè)中線旁丘腦梗死綜合征1例報告[J];中風與神經(jīng)疾病雜志;2001年02期

7 羅文浩,羅韻文,黃本友;丘腦梗死對記憶和智能的影響[J];臨床內(nèi)科雜志;2002年02期

8 翟明,劉江,鐘靜玫,林嵐;雙側(cè)中線旁丘腦梗死6例報道[J];中國醫(yī)師雜志;2003年02期

9 趙正陽,韓勝利,安寧;雙側(cè)中線旁丘腦梗死綜合征兩例[J];中華老年心腦血管病雜志;2003年06期

10 Carrera E. ,Michel P. ,Bogousslavsky J,鄧劍平;丘腦梗死的3個變異分型:前內(nèi)側(cè)型、中央型和后外側(cè)型[J];世界核心醫(yī)學期刊文摘(神經(jīng)病學分冊);2005年04期

相關會議論文 前2條

1 鄧德強;趙進喜;;辨證通絡治療糖尿病丘腦梗死性四肢疼痛3例[A];2005全國中醫(yī)腦病學術(shù)研討會論文匯編[C];2005年

2 張鵬;張士亮;李林文;;以周圍性面癱和延髓麻痹起病的丘腦梗死一例[A];山東省2013年神經(jīng)內(nèi)科學學術(shù)會議暨中國神經(jīng)免疫大會2013論文匯編[C];2013年

相關碩士學位論文 前5條

1 葉夢琦;丘腦梗死46例的臨床分析[D];福建醫(yī)科大學;2016年

2 王思鑒;接觸性熱痛誘發(fā)電位對丘腦梗死脊髓丘腦束功能的初步研究[D];吉林大學;2017年

3 鮑天昊;丘腦梗死與認知功能障礙的初步研究[D];昆明醫(yī)科大學;2012年

4 馬紅蕾;丘腦梗死與認知功能障礙的特點[D];中國醫(yī)科大學;2010年

5 涂坤;丘腦梗死患者認知功能障礙LOTCA評定[D];昆明醫(yī)科大學;2013年

，

本文編號：1741501