本文選題：交感皮膚反應(yīng) + 神經(jīng)病理性疼痛　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景目的:交感皮膚反應(yīng)(Sympathetic skin response,SSR),指的是人體受到一個(gè)內(nèi)源性或外源性刺激,引起交感神經(jīng)系統(tǒng)的興奮,導(dǎo)致皮膚表面電壓改變,隨即出現(xiàn)SSR波形。SSR可檢測(cè)交感神經(jīng)節(jié)后C類無髓小纖維,目前被用來評(píng)估多種疾病的自主神經(jīng)功能,具有敏感性高、快捷無創(chuàng)、易于操作的優(yōu)勢(shì)。目前研究發(fā)現(xiàn),在神經(jīng)病理性疼痛(Neuropathic Pain,NeP)的發(fā)病機(jī)制中,異常的交感神經(jīng)系統(tǒng)發(fā)揮了重要作用,其中交感神經(jīng)節(jié)后C類小纖維參與了多個(gè)環(huán)節(jié)。本研究對(duì)健康志愿者及NeP患者行SSR檢測(cè),目的在于:1.探究NeP患者是否存在自主神經(jīng)功能紊亂。2.探究NeP患者是否有交感神經(jīng)節(jié)后C類小纖維受損證據(jù)。3.研究不同類型NeP之間,如三叉神經(jīng)痛和帶狀皰疹相關(guān)性疼痛之間的SSR表現(xiàn)是否有差異。4.為NeP的機(jī)制研究、診治探索提供啟迪。研究方法:選取21名健康志愿者和41名NeP患者(其中包括14例三叉神經(jīng)痛患者,14例帶狀皰疹相關(guān)性疼痛患者,21例其他類型NeP患者),平均年齡56-62歲,分別組成對(duì)照組、三叉神經(jīng)痛組、帶狀皰疹相關(guān)性疼痛組、其他NeP組。記錄被檢者的基礎(chǔ)信息和病史。行交感皮膚反應(yīng)檢測(cè):使用上海海神牌肌電圖誘發(fā)電位儀,記錄電極貼于雙手心和雙足心,參考電極貼于雙手背和雙足背,地線放在左手腕處,刺激電極陰極朝向遠(yuǎn)端,放在距腕橫紋約3cm處的左正中神經(jīng)體表投影上,刺激強(qiáng)度30mA,刺激持續(xù)時(shí)間0.15ms,靈敏度0.5mV/D,隨機(jī)刺激,測(cè)量起始潛伏期值和峰/峰波幅值,得到SSR結(jié)果。與對(duì)照組相比,病例組SSR異常判定標(biāo)準(zhǔn):1.未引出波形;2.潛伏期對(duì)照組均值+1倍標(biāo)準(zhǔn)差;3.波幅:小于對(duì)照組均值的1/2,或?qū)φ战M均值+1倍標(biāo)準(zhǔn)差。應(yīng)用SPSS19.0軟件統(tǒng)計(jì)分析,對(duì)不同組間SSR表現(xiàn)行t檢驗(yàn),率的比較用卡方檢驗(yàn),得出結(jié)果。當(dāng)P0.05,提示差異有統(tǒng)計(jì)學(xué)意義,當(dāng)P0.01,提示有顯著差異。結(jié)果:1.對(duì)照組和三個(gè)疼痛組被檢者在年齡、性別方面的差異無統(tǒng)計(jì)學(xué)意義,可繼續(xù)比較。2.與對(duì)照組相比,三叉神經(jīng)痛組SSR波幅增高,其中上肢波幅增高,差異具有顯著性,(P0.01),下肢波幅增高,差異具有統(tǒng)計(jì)學(xué)意義,(P0.05),潛伏期無明顯延長(zhǎng)。3.與對(duì)照組相比,帶狀皰疹相關(guān)性疼痛組SSR引出率較低,可引出波幅者其潛伏期延長(zhǎng),其中上肢潛伏期延長(zhǎng),差異具有顯著性,(P0.01),下肢潛伏期延長(zhǎng),差異具有統(tǒng)計(jì)學(xué)意義,(P0.05),波幅無明顯減低或增高。4.與對(duì)照組相比,其他NeP組潛伏期延長(zhǎng),差異具有顯著性,(P0.01),波幅無明顯減低或增高。5.四組間SSR波形引出率為:對(duì)照組(100%)=三叉神經(jīng)痛組(100%)其他NeP組(85.7%)帶狀皰疹相關(guān)性神經(jīng)痛組(64.3%)。率的比較用卡方檢驗(yàn),其他NeP組與對(duì)照組間率的比較無統(tǒng)計(jì)學(xué)意義,P=0.1390.05;帶狀皰疹相關(guān)性疼痛組與對(duì)照組間率的比較有統(tǒng)計(jì)學(xué)意義,P=0.0140.05;帶狀皰疹相關(guān)性疼痛組與其他NeP組率的比較無統(tǒng)計(jì)學(xué)意義,P=0.1390.05。結(jié)論:1.NeP患者存在自主神經(jīng)功能紊亂,臨床上值得關(guān)注。2.三叉神經(jīng)痛者交感神經(jīng)興奮性增高。3.帶狀皰疹相關(guān)性疼痛患者可能存在交感神經(jīng)節(jié)后C類無髓小纖維受損,其中帶狀皰疹者較帶狀皰疹后神經(jīng)痛者更明顯。4.交感皮膚反應(yīng)可作為客觀的電生理手段來評(píng)估疼痛患者的自主神經(jīng)功能。
[Abstract]:Background Objective: Sympathetic skin response (SSR), which means that the human body is stimulated by an endogenous or exogenous stimulus, causing the excitation of the sympathetic nervous system, causing a change in the surface voltage of the skin, and then the SSR waveform.SSR can be used to detect the unmyelinated small fibers of the C class after the sympathetic ganglion, and is currently used to assess the autonomy of a variety of diseases. Neural function has the advantages of high sensitivity, high sensitivity, shortcut and easy to operate. In the present study, the abnormal sympathetic nervous system plays an important role in the pathogenesis of neuropathic pain (Neuropathic Pain, NeP). Among them, the C class of C is involved in many links after the sympathetic ganglion. This study is a study on healthy volunteers and NeP patients. The purpose of SSR detection was to explore: 1. to explore the existence of autonomic nervous dysfunction in NeP patients and.2. to explore whether NeP patients have C type of small fiber damage after sympathetic ganglion.3. study of different types of NeP, such as the mechanism of the difference of.4. for NeP between the SSR manifestations between trigeminal neuralgia and herpes zoster related pain Provide enlightenment. Study methods: 21 healthy volunteers and 41 NeP patients (including 14 patients with trigeminal neuralgia, 14 patients with herpes zoster related pain, 21 other types of NeP), with an average age of 56-62 years, were composed of a control group, a trigeminal neuralgia group, a herpes zoster related pain group, and other NeP groups. Basic information and medical history. Line sympathetic skin reaction test: using the electromyogram evoked potential instrument of Shanghai sea god brand electromyography, recording electrodes attached to the two hands and bipedal hearts, the reference electrode attached to the back of the hands and the dorsum of the double foot, the ground line on the left wrist, and the electrode cathode toward the distal end, and placed on the left median nerve body about 3cm of the wrist transverse. Stimulated intensity 30mA, stimulation duration 0.15ms, sensitivity 0.5mV/D, random stimulation, measured initial latency and peak / peak amplitude, and obtained the SSR results. Compared with the control group, the SSR abnormal criteria of the case group: 1. did not lead to the waveform; the mean value of the 2. latency control group was +1 times standard deviation; the 3. wave amplitude was less than the mean of the control group 1/2, or the mean value +1 times of the control group. Standard deviation. Using SPSS19.0 software statistical analysis, the SSR performance between different groups was tested by t test. The ratio of the rate was checked with chi square test and the results were obtained. When P0.05, the difference was statistically significant. When P0.01, there were significant differences. Results: there was no statistical difference between the 1. control groups and three pain groups at the age, and the difference was not statistically significant, but continued to be compared. Compared with the control group, the amplitude of SSR in the trigeminal neuralgia group was higher, and the amplitude of upper extremity increased, and the difference was significant, (P0.01), the amplitude of lower extremities increased, and the difference was statistically significant, (P0.05), and the latency period was not significantly prolonged,.3. was lower than the control group, and the SSR elicitation rate of herpes zoster related pain group was lower than that of the control group. The latency delayed the amplitude of.3.. Long, the latent period of upper extremity was prolonged, the difference was significant, (P0.01), the latency of lower extremity was prolonged, the difference was statistically significant, (P0.05), the amplitude of wave amplitude was not significantly reduced or increased.4., compared with the control group, the latency of other NeP groups was prolonged, the difference was significant, (P0.01), the amplitude of wave amplitude was not significantly reduced or increased in the.5. four groups, the rate of waveform extraction was as follows: Group (100%) = trigeminal neuralgia group (100%) other NeP group (85.7%) herpes zoster related neuralgia group (64.3%). Compared with the chi square test, there was no statistical difference between the other NeP group and the control group, P=0.1390.05; the comparison between the herpes zoster related pain group and the contrast group was statistically significant, P=0.0140.05; herpes zoster phase. There was no statistically significant difference in the rate of pain in the group of NeP and other groups. P=0.1390.05. conclusion: 1.NeP patients have autonomic nervous dysfunction, which should be clinically concerned with higher sympathetic excitability in.2. trigeminal neuralgia and.3. herpes zoster associated pain patients may be impaired in the C type of unmyelinated small fibers after the sympathic deity, including blisters. Rash is more obvious than herpes zoster neuralgia..4. sympathetic skin response can be used as an objective electrophysiological method to assess the autonomic nervous function of patients with pain.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R741

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 逄紫千;葉玉琴;王可人;張穎;朱丹;黃慶道;;交感神經(jīng)皮膚反應(yīng)在帕金森病中的應(yīng)用[J];中風(fēng)與神經(jīng)疾病雜志;2015年06期

2 婁展;謝炳s，

本文編號(hào)：1900711