体感诱发电位监测联合间歇性充气压力泵在脊柱手术预防下肢深静脉血栓形成中的应用

目的：探讨体感诱发电位监测联合间歇性充气压力泵对脊柱手术患者下肢深静脉血栓（DVT形成的预防效果。方法：选取2021年1月至2021年12月在南昌大学第一附属医院开展脊柱手术的98例患者,采用抽签法分为对照组（间歇性充气压力泵）和观察组（在对照组基础上加体感诱发电位监测）,每组49例。比较两组下肢肿胀、疼痛及DVT发生情况、D-二聚体水平以及观察组中发生DVT和未发生DVT患者双下肢体感诱发电位各波潜伏期情况。结果：观察组下肢肿胀、疼痛及DVT发生率均低于对照组（P<0.05）。手术结束后两组D-二聚体水平均高于手术前,但观察组低于对照组（P<0.05）,干预后两组患者D-二聚体水平明显降低,且观察组低于对照组（P<0.05）。观察组中发生DVT患者的双下肢体感诱发电位各波潜伏期均长于未发生DVT患者（P<0.05）。结论：体感诱发电位监测联合间歇性充气压力泵能有效预防脊柱手术患者DVT的发生。     

帕金森病患者正中神经和胫神经体感诱发电位研究

目的:同时观察帕金森病患者正中神经和胫神经体感诱发电位的异常并推测其发生机制。方法:选择30名帕金森病患者和20名健康对照者,刺激正中神经,记录顶叶体感诱发电位的N20、P25、N30波,额叶的P20、N30波的潜伏期和波幅。刺激胫神经,记录顶叶体感诱发电位的P40、N50、P60波的潜伏期和波幅。结果:帕金森病患者上肢额叶N30和下肢N50波幅明显降低(P<0·05)。结论:帕金森病患者上下肢SEP同时出现异常是黑质纹状体系统多巴胺缺乏的结果,下肢N50波幅比上肢N30与临床症状的严重性更有相关性。     

114例神经衰弱的体感诱发电位分析

以８０例正常健康人的体感诱发电位结果为标准，对１１４例神经衰弱的体感诱发电位进行回顾性分析。结果发现，７１．１％的神经衰弱患者体感诱发电位异常，表现为波型畸变、潜伏期延长和波幅异常。表明神经衰弱患者存在脑功能障碍，体感诱发电位是评价神经衰弱患者脑功能损害的较敏感的客观指标。     

关于下肢体感诱发电位P50的探讨

目的：探讨下肢体感诱发电位P50的临床价值。方法：用常规检查方法，检测下肢体感诱发电位，观察P50波形在正常和多种神经科疾病人群中的分布情况。结果：在正常人群中未发现P50波形存在，但在29种疾病中可发现P50波的存在。结论：下肢体感诱发电位P50是指在P40和P60波之间的一个新波形，其本质还不十分清楚。P50可能在神经科的某些疾病如：糖尿病周围神经病、多发性硬化、重症肌无力等疾病中存在，对其诊断可有一定的帮助作用。     

皮层运动诱发电位监测在脑中央区术中的应用

目的:探讨在全凭静脉麻醉下,使用皮层运动诱发电位(MEP)对脑中央区手术进行术中监测的方法。方法:使用皮层电极对12例中央区肿瘤患者进行诱发电位术中监测,在中央后回感觉皮层区相应部位记录皮层体感诱发电位(SEP)的N20-P25波,沿中央后回功能区皮层向前移动电极,直至记录到一个波型相反(位相倒置)、波幅相近的波型P20-N25,将其定为运动中枢刺激点。使用高频串刺激(TS)直接刺激该点,在上肢肌肉记录MEP。结果:12例患者均能成功地记录到MEP。术中注意保护此区,术后患者症状无明显加重,被监测的上肢肌力无明显减退。结论:对于脑中央区手术,在全凭静脉麻醉下找出运动中枢刺激点并作MEP监测(术中注意保护此区)是一种优良的术中监测手段。     

下肢体感诱发电位监测在胸椎手术中的应用

目的：探讨下肢体感诱发电位（SEP）监测在胸椎手术中的应用价值。方法：回顾性分析23例患者的胸椎手术资料,分析下肢SEP的P40与手术操作、术后恢复的关系。结果：23例患者中,17例监测皮层SEP未达到报警标准;5例达到报警标准,采取保护性措施后恢复正常;1例假阴性,术后下肢功能障碍。结论：SEP能连续监测而不干扰手术,用于术中监测以保护脊髓传导功能。     

体感诱发电位检测在脑卒中预后评估中的作用

目的 双上肢体感诱发电位检测在脑卒中预后评估中的作用.方法 95例患者头颅CT明确脑卒中(而且偏瘫侧肌力0-1级)后检测双上肢体感诱发电位,然后采用药物治疗、综合康复措施治疗,治疗时间为6周.结果 95例患者经过为期6周的药物、综合康复治疗后,双侧体感诱发电位N20波幅比小于50%18例,显效(肌力4-5级)11例(61%)、有效(肌力2-3级)7例(39%)、无效(肌力0-1级)0例(0%).双侧体感诱发电位N20波幅比大于50%小于90%32例,显效(肌力4-5级)11例(34.4%)、有效(肌力2-3级)例17(53.1%)、无效(肌力0-1级)4例(12.5%)双侧体感诱发电位N20波幅比大于90%45例,显效(肌力4-5级)5例(11.1%)、有效(肌力2-3级)28例(62.2%)、无效(肌力0-1级)12例(26.7%).结论 双上肢体感诱发电位检测对脑卒中预后评估有积极指导作用.     

高颅压患者的体感诱发电位表现

目的：观察颅内压（ICP）增高对体感诱发电位（SEP）的影响。方法：对86例颅内病变引起的高颅压病人治疗前后进行体感诱发电位检测。同时测定患者脑压及血压。结果：ICP升高时SEP各波潜伏期延长，波幅降低，以N20波最明显，呈高度负相关，结论：SEP参数改变可间接推断ICP变化，并有助于病情及预后的判断。     

神经根型颈椎病手术治疗的肌电图与体感诱发电位指征

目的：联合肌电图（EMG）与体感诱发电位（SEP）检查探索神经根型颈椎病手术治疗的客观指征.方法：72例待行颈椎前路减压植骨融合术治疗的神经根型颈椎病患者,根据肌电图与体感诱发电位检查结果分为轻、中、重度3组.比较3组患者颈椎功能障碍指数（NDI）的恢复程度.结果：根据EMG与SEP检查结果,轻度组患者21例,中度组患者26例,重度组患者25例.3组术后NDI评分均较术前有显著恢复（P＜0.05）,轻、中度组恢复至轻度功能障碍,重度组恢复至中度功能障碍.结论：肌电图或体感诱发电位异常,而腋神经运动潜速率正常且SEP的N13波形尚清晰是神经根型颈椎病接受手术治疗的电生理指征.     

脊髓体感与运动诱发电位术中联合监测的应用价值

目的：探讨脊髓体感诱发电位(SEP)与运动诱发电位(MEP)在脊髓手术中联合监测的临床应用价值。方法：对18例脊柱手术患者进行术中SEP和MEP联合监测，并用日本矫形学会量表(JOA)对患者术后神经功能进行评价。结果：全部患者术中SEP的P1、N1波幅有暂时性波动，潜伏期无明显变化。10例患者MEP的D1波波幅降低，但经改变手术方向后恢复正常，另8例患者MEP无明显变化。术后JOA评分较术前明显改善。结论：SEP及MEP术中联合监测，其波形稳定可靠，有利于避免“假阴性／假阳性”结果及术后神经功能障碍的发生。     

单脉冲和双脉冲液电式体外冲击波粉碎结石术的数值模拟

目的通过数值模拟研究体外冲击波粉碎结石术(extracorporeal shock wave lithotripsy,ESWL)中单脉冲与双脉冲两种不同情况下的压力场,并对两者结果进行比较和分析。方法利用2D轴对称Euler方程和混合网格改进的时空守恒元解元(space-time conservation element and solution element,CE/SE)数值格式,对ESWL中冲击波水下传播的压力场进行模拟。结果 CE/SE方法成功地追踪了冲击波波阵面传播情况,数值解较好地展示了ESWL焦点附近的冲击波聚焦特性:在焦点附近双脉冲产生的压力峰值约为单脉冲的两倍,越靠近焦点处双脉冲ESWL所得到的碎石效率相较于单脉冲时越高,且在焦点附近产生正压随后出现了绝对值极高的负压。结论采用液电双脉冲波源机型能够有效地提高碎石效率,并且冲击波聚焦时出现空化是不可避免的。上述结论为ESWL碎石机的设计制造及临床应用提供了可靠的数值模拟结果。     

胫后神经体感诱发电位对脊髓病变的定位诊断

目的：研究胫后神经体感诱发电位对脊髓病变的定位诊断价值。方法：通过经皮恒流电刺激胫后神经，采用髂棘、脐部和头皮Fpz作参考电极，分别于第4腰椎棘突、第12胸椎棘突和头皮Cz’置记录电极，依次记录CE、N24和P40电位之峰潜伏期。共检测15例健康成人和29例经核磁共振证实的腰骶神经根或脊髓病变患者。结果：①CE、N24和P40电位均异常，见于腰骶神经根病变；②CE正常，N24和P40异常，见于腰骶髓病变；③CE、N24正常，P40异常，见于颈胸髓病变。结论：胫后神经体感诱发电位能够鉴别腰骶神经根或不同节段的脊髓病变，临床上具有定位诊断价值。但对于轻度的腰骶神经根或脊髓腹侧病变，结果可出现“假阴性”。     

Lesions in the bed nucleus of the stria terminalis disrupt corticosterone and freezing responses elicited by a contextual but not by a specific cue-conditioned fear stimulus

The bed nucleus of the stria terminalis (BNST) is believed to be a critical relay between the central nucleus of the amygdala (CE) and the paraventricular nucleus of the hypothalamus in the control of hypothalamic-pituitary-adrenal (HPA) responses elicited by conditioned fear stimuli. If correct, lesions of CE or BNST should block expression of HPA responses elicited by either a specific conditioned fear cue or a conditioned context. To test this, rats were subjected to cued (tone) or contextual classical fear conditioning. Two days later, electrolytic or sham lesions were placed in CE or BNST. After 5 days, the rats were tested for both behavioral (freezing) and neuroendocrine (corticosterone) responses to tone or contextual cues. CE lesions attenuated conditioned freezing and corticosterone responses to both tone and context. In contrast, BNST lesions attenuated these responses to contextual but not tone stimuli. These results suggest CE is indeed an essential output of the amygdala for the expression of conditioned fear responses, including HPA responses, regardless of the nature of the conditioned stimulus. However, because lesions of BNST only affected behavioral and endocrine responses to contextual stimuli, the results do not support the notion that BNST is critical for HPA responses elicited by conditioned fear stimuli in general. Instead, the BNST may be essential specifically for contextual conditioned fear responses, including both behavioral and HPA responses, by virtue of its connections with the hippocampus, a structure essential to contextual conditioning. The results are also not consistent with the hypothesis that BNST is only involved in unconditioned aspects of fear and anxiety.     

阈值强度刺激BAEP检测在梅尼埃病的应用

目的：探讨阈值强度刺激在梅尼埃病（ＭＤ）ＢＡＥＰ检测中的应用价值。方法：对３６例ＭＤ患者４６只耳同时进行阈上强度刺激ＢＡＥＰ检测和阈值强度刺激检测,并和２５例正常人５０只耳检测结果进行比较。结果：ＭＤ组４６只耳阈上强度刺激ＢＡＥＰ检测２只耳Ⅰ波潜伏期延长,１３只耳Ⅰ波缺失,异常率３３％。而阈值强度刺激时ＢＡＥＰ反应阈增高者３６只耳,异常率７２％,两者差异显著（Ｐ＜００１）。与正常对照组Ｖｔ波潜伏期（均值７９５ｍｓ）比较,ＭＤ组Ｖｔ波潜伏期（均值６６５ｍｓ）缩短,有显著差异Ｐ＜００１）。结论：阈值强度刺激可显著提高ＭＤＢＡＥＰ检测阳性率,Ｖｔ波潜伏期＜７０ｍｓ可作为判断蜗性损害的一项客观指标     

Ipsilateral responses of motor evoked potential correlated with the motor functional outcomes after cortical resection

The aim of this study was to evaluate if ipsilateral motor evoked potential (MEP) elicited by transcranial magnetic stimulation (TMS) could provide neurosurgeons preoperatively with useful information regarding surgical procedure for patients with severe cerebral hemiatrophy or unilateral malformation. Thirteen epilepsy patients with severe cerebral hemiatrophy or unilateral malformation were studied before operation using MEPs recorded on bilateral abductor pollicis brevis (APBs) muscles, elicited by transcranial magnetic stimulation of the motor cortex. Ten subjects served as controls. Results: (1) no ipsilateral MEP responses were recorded in all the 10 healthy subjects; (2) in the 13 patients, the results of MEPs could be divided into four types. Type A: in 3 patients bilateral MEPs were recorded when unaffected hemisphere was stimulated, while no responses were elicited when the affected hemisphere was stimulated. Type B: in another 3 patients, the MEPs were elicited from bilateral APB muscles when the unaffected hemisphere was stimulated, and the contralateral MEP was also elicited when the affected hemisphere was stimulated. Type C: in two patients contralateral MEP was elicited when the unaffected hemisphere was stimulated, while no MEP was induced in APB muscles of either side following the affected hemisphere stimulation. Type D: in the remaining 5 patients, contralateral magnetic MEPs were elicited either when the affected or the unaffected hemisphere was stimulated. Patients of type A, B and C received hemispherectomy showed no significant permanent motor functional deficit. Among the total 8 patients, 7 patients got seizure free after the operation. Patients of type D showed minor muscle strength decrease after localized cortical resection. Three out of 5 patients of type D got seizure free after the operation. Ipsilateral MEP response might be useful for neurosurgeons to plan appropriate surgical procedure which helps avoid post-operative motor deficits.     

颞叶肿瘤病人智商、记忆商与P_3测试分析

目的：研究颞叶占位患者事件相关电位（ＥＲＰ）Ｐ３的变化特点及与智商（ＭＱ）、记忆商（ＩＱ）的关系。方法：对１５例颞叶肿瘤病人采用视觉分辨刺激序列测查Ｐ３,临床记忆量表、瑞文智力测验联合型测查记忆商（ＭＱ）和智商（ＩＱ）。结果：颞叶占位病人组有Ｐ３潜伏期的显著延长及波幅的降低,记忆商和智商明显低于对照组,未发现Ｐ３潜伏期与记忆商、智商之间的相关性。结论：颞叶病人Ｐ３潜伏期延长反映了认知功能的变化,Ｐ３潜伏期与记忆商、智商无明显相关性的原因可能与所采用的刺激序列有关     

皮瓣和肌皮瓣移植加创面灌洗修复截瘫后多发性压疮

背景：压疮是截瘫患者的常见并发症,严重的压疮通过保守治疗难以治愈。 目的：观察皮瓣和肌皮瓣加创面灌洗治疗截瘫患者多发性压疮的修复效果。 方法：纳入2007-01/2010-12在北京积水潭医院烧伤整形科治疗的16例多部位严重压疮的截瘫患者,均伴有不同程度的骨质破坏。手术中彻底扩创,去除死骨、瘢痕及感染肉芽组织,以皮瓣或肌皮瓣覆盖创面,术后灌洗治疗。 结果与结论：纳入的16例患者创面全部Ⅰ期愈合,出院3个月后随访,修复部位压疮均未出现复发。说明皮瓣和肌皮瓣修复加创面灌洗治疗对截瘫患者压疮有良好的修复效果。     

脊髓亚急性联合变性的临床特征与电生理检查

目的：评价脊髓亚急性联合交性(SCD)的临床特征与电生理检查的诊断价值。方法：回顾分析了16例SCD患的临床特点以及电生理检查等资料。结果：16例SCD患全部由维生素B12缺乏引起，慢性胃炎及胃大部切除术是其主要病因。肢体感觉异常、深感觉减退、感觉性共济失调及痉挛性截瘫是其主要症状和体征。11例患合并周围神经损害，1例脑白质受损。9例肌电图检查显示周围神经损害、8例SEP呈中枢传导受损，电生理检查均有阳性发现。7／12血清维生素B12浓度测定低于正常。结论：血清维生素B12浓度正常并不能完全排除SCD；电生理检查高度敏感，对SCD的早期诊断意义重大。     

The significance of ST and T changes for the development of coronary events in patients with acute coronary chest pain, treated in a coronary care unit without verified acute myocardial infarction

The one-year prognosis for patients with a confirmed diagnosis of acute myocardial infarction (AMI) was compared with that of non-AMI patients treated in the coronary care unit (CCU). The one-year incidence of coronary events (CE) after discharge from CCU was 37% in the 51 AMI patients and 20% in the 81 non-AMI patients. The one-year mortality rates were 27 and 4%, respectively. Among the non-AMI patients, well known risk factors such as hypertension, previous AMI, congestive heart failure, smoking, diabetes and hyperlipaemia were not more common in those who developed a CE. ST segment depression and T wave inversion, each of at least 0.1 mV, in three or more ECG leads were selective criteria for a high-risk group with respect to CE. Preventive measures should be considered in this group of patients without verified AMI.     

动态脑电图加心脏导联监测对晕厥与癫(癎)的鉴别诊断价值

目的:探讨24小时动态脑电图(AEEG)加心脏导联监测对晕厥与癫的鉴别诊断价值。方法:对92例以昏倒就诊,但常规脑电图(REEG)和心电图(ECG)均阴性的患者做24小时AEEG加心脏导联监测,并结合临床进行观察。结果:46例AEEG检测到多次阵发性棘波、尖波、棘慢波综合、尖慢波综合等样放电而诊断为癫,24例诊断为晕厥(心源性晕厥占58.3%,脑源性晕厥占25%,反射性晕厥占16.7%),6例不能定性,16例正常,总阳性率为82.6%。结论:24小时AEEG加心脏导联监测能帮助鉴别临床以昏倒发作的晕厥与癫,并能区分晕厥的类型。