职业性慢性正己烷14例中毒患者神经-肌电图的初步观察

目的观察正己烷中毒患者的临床及神经-肌电图的变化。方法对病例组14例及对照组10例作神经-肌电图检查,并进行对比分析。结果14例患者神经传导速度检查结果与对照组相比,各条神经的运动神经传导速度（MCV）和感觉神经传导速度（SCV）均显著减慢（P〈0.01）,大部分周围神经远端潜伏期延长;肌电图检查显示,放松时部分病例出现纤颤电位或正锐电位,肌肉大力收缩时,部分病例出现单纯相或混合相。结论职业性慢性正己烷中毒患者神经-肌电图表现为周围神经MCV及SCV的显著减慢,远端潜伏期的延长,部分病例肌电图表现为失神经支配。临床表现为四肢末端周围神经损害表现。     

神经肌电图检测在腕管综合征临床诊断中的价值

【摘要】目的探讨神经肌电图检测在腕管综合征（CTS）临床诊断中的价值。方法对68例健康体检者（对照组）和60例CTS患者（CTS组）进行正中神经、尺神经的运动神经传导速度（MCV）和感觉神经传导速度（scv）、感觉神经动作电位波幅（SNAP）、复合肌肉动作电位波幅（cMAP）、肌电图等测定并比较分析。结果CTS组正中神经指1．腕、指3．腕、指4桡侧．腕SCV和SNAP均明显低于对照组[（35．6±3．2）m／s比（50．1±3．5）m／s、（35．8±3．1）m／s比（55．1±3．5）m／s、（35．8±3．2）m／s比（53．1±3．4）m/s,（7．6±3．9）μV比（28．0±7．0）μV、（8．3±3．1）μV比（26．0±6．6）μV、（7．5±3．3）μV比（25-3±7．2）μV],差异有统计学意义（P〈0．05）。两组尺神经指4尺侧-腕、指5-腕SCV和SNAP比较差异无统计学意义（P〉0．05）。CTS组正中神经腕．大鱼际肌潜伏期明显高于对照组[（5．0±2．2）ms比（3．0±0．4）ms],CMAP明显低于对照组[（3．1±2．3）mV比（11．2±3．1）mV],差异有统计学意义（P〈0．05）。CTS组正中神经SCV减慢或未引出电位60例,异常率100．0％（60／60）,波幅降低54例,异常率90．0％（54／60）。正中神经运动潜伏期延长或未引出50例,异常率83．3％（50／60）,波幅降低43例,异常率71．6％（43／60）。CTS组尺神经和正中神经指4．腕SCV差值异常率为100．0％（60／60）。结论神经肌电图检测在CTS临床诊断中具有重要的价值,值得临床推广。     

丙烯酰胺作业工人神经传导速度测定结果分析

我们对50名接触丙烯酰胺(AAm 的)作业工人,平均工龄为7.8年,做肌电图测定神经传导速度,并以60名不接触 AAm 的医院工作人员作对照。测定结果表明,各神经末端潜伏期、运动神经传导速度(MCV),感觉神经传导速度(SCV)的异常率,接触组与对照组比较明显延长或减慢,有非常显著意义(P<0.01).感觉神经活动电位也比对照组为低。     

丁咯地尔与丹参注射液对糖尿病周围神经病变疗效比较和安全性分析

目的：比较盐酸丁咯地尔氯化钠注射液与复方丹参注射液对糖尿病周围神经病变（DPN）的治疗疗效和安全性。方法：采用盐酸丁咯地尔氯化钠注射液（治疗组）治疗DPN患者48例,复方丹参注射液（对照组）治疗DPN患者42例,治疗前后化验空腹及餐后血糖、血脂,测量血压,计算体重指数,用肌电图测量正中神经、腓总神经、胫神经的感觉传导速度（SCV）及运动传导速度（MCV）。结果：两组治疗后患者自觉症状均有所改善,治疗组和对照组有效率分别为94．5％、81．6％。两组患者治疗后正中神经、腓总神经、胫神经的MCV及SCV均明显提高,治疗组提高更明显（P0．01）。整个治疗过程中,两组均未发生不良反应。结论：盐酸丁咯地尔氯化钠注射液治疗DPN患者疗效显著、不良反应少,值得临床推广使用。     

铅作业工人神经肌电图改变与血铅水平关系的研究

本文对140名铅作业工人进行了神经肌电图检查和血铅测定,发现正中神经感觉传导速度随血铅升高而减慢,呈显著负相关;正中神经、尺神经的传导速度和末端潜伏期改变与血铅水平有关,呈接触水平-反应关系。末端潜伏期的异常率在血铅超过1.93～2.41μmol/L时显著增高。拇展短肌、小指展肌和伸指总肌的肌电图改变主要表现为小力收缩时运动单位电位多相电位数显著增多和大力收缩时显示的运动单位电位数目显著减少。     

奥克托今对作业工人周围神经传导速度的影响

目的 探讨奥克托今（HMX）对作业工人周围神经传导速度的影响。方法 选取76名接触HMX的作业人员为接触组。并以38名不接触HMX和神经毒物质的健康人作为对照。按标准方法测定正中神经，尺神经，腓总神经运动传导速度和感觉传导速度及运动潜伏期，同时测定车间空气中HMX浓度。并对不同接触浓度和不同作业工龄进入地比较。结果 接触组腓总神经远端运动潜伏期明显延长，正中神经近端感觉传导速度明显减慢，高浓度接触组正中神经，尺神经远端感觉神经潜伏期较低浓度组明显延长。20年以上工龄组正中神经，尺神经，腓总神经运动传导速度和正中神经感觉传导速度明显减慢，接触组腓总神经运动传导速度异常检出率明显高于对照组。结论 HMX对下肢神经传导速度影响明显，并与接触。浓度和作业工龄长短关系密切，但HMX影响周围神经传导速度的机制还不清楚，是否与神经递质释放有关，有待进一步探讨。     

低温对家兔振动性神经功能的损伤

[目的]探讨家兔低温敏感性与振动性神经功能损伤之间的相关性。[方法]首先对家兔进行低温试验,按照试验前后测定指标的变化情况,确定内皮素（ET）、感觉神经传导速率（SCV）为低温敏感性指标。根据低温试验前后ET、SCV的变化情况分别进行分组。前后变化〈25％者为低度敏感组;变化25％～50％者为中度敏感组;变化〉50％者为高度敏感组。分组后,低、中、高度敏感组家兔分别为15、13、12只。然后,进行接振试验,测定各组家兔接振后SCV、感觉神经动作电位波幅、感觉神经动作电位潜伏时、运动神经传导速率（MCV）、运动神经远端波幅、运动神经远端潜伏时的变化。[结果]与接振试验前比较,接振后SCV、MCV、感觉神经动作电位波幅、运动神经远端波幅降低,感觉神经动作电位潜伏时、运动神经远端潜伏时延长（P〈0．05）。SCV、MCV、感觉神经动作电位波幅、运动神经远端波幅在低、中、高敏感组依次降低;感觉神经动作电位潜伏时、运动神经远端潜伏时依次延长,差异有统计学意义（P〈0．01）。将低温试验后的血浆ET浓度、SCV测定值与接振后的振动性神经功能损伤指标SCV（r=-0．872,r=0．847）、感觉神经动作电位波幅（r=-0．750,r=-0．925）、感觉神经动作电位潜伏时（r=0．850,r=-0．799）、MCV（r=-0．705,r=0．843）、运动神经远端波幅（r=-0．943,r=0．940）、运动神经远端潜伏时（r=0．941,r=-0．931）的测定值进行简单相关分析,结果显示上述相关系数r值均具有统计学意义（P〈0．01）。[结论]低温敏感性与振动性神经功能损伤具有相关性;振动性神经功能损伤在低、中、高3个敏感组中依次加重;但两者相关性的原因尚待研究。     

手传振动累积接振剂量与正中神经感觉传导关系的研究

目的探讨接振工人累积接振剂量与正中感觉神经损伤的剂量-反应关系,以及手传振动对神经损伤的客观敏感指标。方法以102名40岁以下的接振工人为研究对象,对每名工人进行基本信息收集,检测正中感觉神经传导速度和运动电位波幅,检测他们所在车间岗位的接振强度和接振时间,估算他们的累积接振剂量,将累积接振剂量分别与正中感觉神经传导速度和运动电位波幅进行相关分析。结果累积接振剂量与正中感觉神经传导速度呈负相关(r=-0.217 P0.05),累积接振剂量与正中感觉神经运动电位波幅相关性无统计学意义(P0.05)。接振高剂量工人(累积接振剂量≥20 000hm2/s4)左手正中神经感觉传导速度明显低于接振低剂量工人(累积接振剂量20 000hm2/s4)(T=-2.166,P0.05)。结论手传振动影响接振工人的正中感觉神经传导速度,会导致正中感觉神经传导速度减慢。正中神经感觉传导速度是反映振动性神经病较好的客观指标。     

职业接触1-溴丙烷对神经系统的影响

选取山东和广东两省的7家生产或使用1-溴丙烷(1-BP)企业共计85名工人作为接触组,同时选取同企业91名行政办公人员作为对照组,对临床资料、触觉延迟检查和神经-肌电图等结果进行分析。检查发现双脚震动觉延迟时间接触组和对照组差异有统计学意义,双下肢延迟时间较对照组延长(P=0.000)。两组运动神经传导速度检测可见正中神经末端潜伏期(DML)、传导速度(MCV)、胫后神经末端潜伏期(DML)差异有统计学意义(P0.05),正中神经感觉传导速度(SCV)差异有统计学意义。职业接触1-BP可引起工人神经症状、震动觉和神经-肌电图的改变,我国l-BP接触工人作业环境整体情况不容乐观。     

32例职业性轻度手臂振动病综合治疗前后神经电生理分析

目的 比较综合治疗前后手臂振动病患者神经电生理变化情况,观察其治疗效果.方法 对初次诊断及经过3个月综合治疗的32例轻度手臂振动病患者,进行神经电生理检查结果对比分析.结果 治疗后神经肌电生理基本恢复正常19例(59.38%);正中神经、尺神经运动传导远端潜伏期延长发生率从治疗前的90.63%和35.94%下降至治疗后的23.44%和1.56%(P<0.01);远端感觉神经传导速度(SCV)减慢发生率从治疗前的29.69%和23.44%下降至治疗后的3.13%和4.69%(P<0.01).结论　手臂振动病早期神经电生理主要表现为正中神经、尺神经运动传导远端潜伏期延长和SCV减慢,综合治疗后各指标可明显改善,提示对于手臂振动病早期治疗效果是显著的.     

Electroneurographic findings in workers exposed to mercury]

25 mercury-exposed workers as well as 27 age-matched controls were investigated in an electroneurographic study. The population of mercury-exposed workers was found to have --an increased latency of distal motor action potential at both median and peroneal nerves --an increased latency of distal sensory action potential at median nerve --a decrease of amplitudes of evoked muscle potentials at both median and peroneal nerves --a reduced motor nerve conduction velocity at both examined nerves --a reduced antidromic sensory nerve conduction velocity at median nerve. To detect early changes in nerval function we recommend regularly electroneurographic examinations of mercury-exposed people.     

慢性职业性止己烷中毒患者神经-肌电图表现特征分析

[目的]分析职业性正己烷中毒患者神经肌电图表现的特征,明确肌电图表现改变在正己烷中毒诊断中的作用。[方法]对某电子企业2009年9名正己烷中毒患者进行深度调查,收集工人的职业吏并对接触毒物进行鉴定,所有患者进行神经专科检查和定期神经肌电图检查,观察中毒患者神经肌电表现的特征。[结果]9例患者都有确切的正己烷接触史,神经电生理检查显示肌肉自发电位增多,收缩时相位异常,神经传导速度下降（P〈0．01）．远端潜伏期延长（P〈0．01）,波幅下降（P〈0．05o经营养神经对症处理辅以运动锻炼治疗后9例患者均有好转（P〈0．05o［结论]正己烷慢性中毒患者神经肌电图表现为周围神经受损,运动神经较感觉神经严重,入院治疗后临床症状好转先于神经肌电图改变,在评价恢复程度时应更注重临床表现而不导神终肌电检查。     

Effects on the peripheral nervous system of tunnel workers exposed to acrylamide and N-methylolacrylamide

OBJECTIVES: This study evaluates the possible toxic effects on the peripheral nervous system of tunnel workers exposed to acrylamide and N-methylolacrylamide during grouting work. METHODS: Symptoms and nerve conduction velocities (NCV) were recorded for 24 tunnel workers 4 and 16 months after the cessation of exposure during grouting operations. Fifty tunnel workers not involved in grouting operations served as referents. Exposure was assessed by questionnaires, qualitative exposure indices, and measurements of hemoglobin adducts after the cessation of exposure. RESULTS:The exposed workers reported a higher prevalence of symptoms during grouting work than they did in an examination 16 months later. A statistically significant reduction in the mean sensory NCV of the ulnar nerve was observed 4 months postexposure when compared with the values of the reference group (52.3 versus 58.9 m/s, P = 0.001), and the mean ulnar distal delay was prolonged (3.1 versus 2.5 ms, P = 0.001). Both measures were significantly improved when measured 1 year later. Exposure-related improvements were observed from 4 to 16 months postexposure for both the median (motor and sensory NCV and F-response) and ulnar (sensory NCV, F-response) nerves. A significant reversible reduction in the mean sensory amplitude of the median nerve was also observed, while the mean sensory amplitude of the sural nerve was significantly reduced after 16 months. CONCLUSIONS: The results indicate demyelinating and axonal changes in peripheral nerves of tunnel workers in relation to exposure to N-methylolacrylamide and acrylamide during grouting operations. The changes were slight, mostly subclinical, and most of the effects were reversible, with normalization after 1 year.     

振动性神经病的实验和临床研究

探讨振动性神经病的神经功能改变及其评价指标。以家兔为实验对象,测定振动负荷前 坐骨神经传导速度的变化与非接振家兔相对照,以砂轮磨光工为对象,进行现场调查,健康检查,测定其短潜伏时体感诱发电位,正中神经的感觉和运动神经传导速度,并与对照工人比较。     

Vibration-induced multifocal neuropathy in forestry workers: electrophysiological findings in relation to vibration exposure and finger circulation

Objectives: To investigate neural conduction in the upper limbs of symptomatic forestry workers with and without exposure to hand-transmitted vibration. A further aim was to assess the possible relationships between vibration exposure, nerve conduction and finger circulation in the forestry workers who used chain saws. Methods: A detailed neurophysiological investigation was performed on the upper extremities of 20 chain saw workers, 20 forestry operators with heavy manual work but without vibration exposure, and 20 healthy male controls. All subjects were screened to exclude polyneuropathy. Measurements of sensory and motor nerve conduction (velocity and amplitude) were obtained bilaterally from the median, ulnar and radial nerves. To assess peripheral vascular function, the forestry workers underwent a cold test with plethysmographic measurement of finger systolic blood pressure (FSBP). In the chain saw operators, vibration exposure was evaluated according to the International Standard ISO 5349. Indices of daily vibration exposure and lifetime cumulative vibration dose were estimated for each chain saw operator. Results: Sensory nerve conduction in several segments of the median and radial nerves was significantly reduced in the chain saw operators compared with that in the workers doing heavy manual work and the controls. The neurophysiological pattern more frequently observed in the chain saw operators was a multifocal nerve conduction impairment to several neural segments with predominant involvement of sensory rather than motor fibres. Sensory nerve conduction velocities in the hands of the chain saw operators were inversely related to both daily and lifetime cumulative vibration exposures. In the vibration-exposed forestry workers, neither were sensori-motor complaints associated with vascular symptoms (finger whiteness) nor were electrophysiological data related to cold-induced changes in FSBP. Conclusions: Exposure to hand-transmitted vibration, in addition to ergonomic stress factors, can contribute to peripheral nerve disorders occurring in forestry workers who operate chain saws. The findings of this study suggest the existence of an exposure-effect relationship for vibration-induced neuropathy. Different underlying mechanisms are likely to be involved in the pathogenesis of the neurological and vascular components of the hand-arm vibration syndrome. Received: 18 November 1999 / Accepted: 25 April 2000     

Neuropathy and the automatic analysis of electromyographic signals from vibration exposed workers.

An automatic analysis of the electromyographic activity of the extensor digitorum communis, first dorsal interosseus and opponens pollicis muscles was performed, and both motor and sensory conduction velocities of the median and ulnar nerves were measured in the study of neuropathic changes that occur in traumatic vasospastic disease. Twenty-eight forest workers and 10 pneumatic-tool operators, all with a long occupational exposure to local vibration of the hands, were studied with these neurophysiological methods and general clinical and roentgenological examinations. Twenty male manual workers with a similar age distribution served as the comparison group. The most sensitive measures which separated the subjects with traumatic vasospastic disease from the nonexposed workers were the conduction velocity of the slower motor fibers of the ulnar nerve, the distal sensory conduction velocity and the motor distal latency of the median nerve. The duration and rise time of the averaged muscular potentials of intrinsic hand muscles correlated especially with those nerve conduction velocities which were the most sensitive in exhibiting neuropathic changes.     

Peripheral neurotoxicity in workers exposed to inorganic mercury compounds

Nerve conduction velocity (NCV) of the median motor, median sensory, and sural nerves was assessed in 16 workers chronically exposed to various inorganic mercury compounds. Exposed workers were compared with an unexposed control group using t test analyses. Slowing of the median motor nerve NCV was found, which was correlated with both increased levels of mercury in blood and urine, and with increased number of neurologic symptoms. Sensitive evaluation of neural function was found to be practical and informative for investigating mercury toxicity. Such evaluation can help determine safe mercury levels at the workplace.     

Peripheral nerve conduction velocities in chain-saw operators.

The motor, sensory and mixed nerve conduction velocities of median and posterior tibial nerves were measured in seventeen forest workers engaged in chain-saw operation for 2 to 16 yr (mean 12 yr). The conduction velocities were significantly diminished in the distal part of the upper limb. The sensory nerve conduction velocities (SCV) of the median nerve at the part of the palm were slow in 12 workers; longer residual latency, in 6; and the mixed nerve conduction velocities slowed at the part of the forearm, in 6. From the relationships of the nerve conduction velocities to white finger attacks and electromyograms, it was assumed that vibration directly affected the distal part of the sensory and motor nerve fibers in the upper limbs, and that the diminished SCV in the palm was one of the most sensitive indices of vibration effects.     

α-硫辛酸联合甲钻胺治疗糖尿病外周神经病变的效果观察

目的评价应用α-硫辛酸联合甲钴胺治疗糖尿病外周神经病变的临床效果。方法选取糖尿病外周神经病变患者90例,按随机数字表法分为两组,每组45例,观察组给予α-硫辛酸联合甲钴胺治疗,对照组给予α-硫辛酸治疗,经过3周的药物治疗后观察患者的临床表现与肌电图情况,并进行分析比较。结果观察组的总有效率显著高于对照组[93．3％（42／45）比55．6％（25／45）],差异有统计学意义（P〈0．05）;观察组患者的腓总神经感觉传导速度治疗后显著高于对照组[（49．5±3．2）m／s比（40．2±2．9）m／s],差异有统计学意义（P〈0．05）;正中神经感觉传导速度,正中神经和腓总神经运动传导速度比较差异无统计学意义（P〉0．05）。在药物治疗期间和治疗后,患者均未出现不良反应。结论利用α-硫辛酸联合甲钻胺治疗糖尿病外周神经病变患者,可有效改善患者的临床症状,具有较好的临床效果。     

接触正已烷致工人周围神经损害的研究

目的研究接触正己烷致工人周围神经损害的影响。方法对206名接触正己烷的工人和128名对照组进行问卷、内科体检和神经传导速度及尿中2,5-己二酮、血清神经特异性烯化酶(NSE)水平测定。结果上帮车间正己烷浓度超过国家接触限值;下帮车间未超标。上帮车间组工人有乏力、肢麻、行走不便、下蹲起立困难、肌肉萎缩、跨越步态、肌力下降、浅感觉减退、腱反射减退等症状体征,与下帮车间组及对照组相比,差异有显著性(P<0.01)。测定248根运动神经传导速度中172根(69.3%)传导速度减慢,62根(25.0%)波幅下降;32根(12.9%)远端潜伏期延长;186根感觉神经中141根(75.8%)传导速度减慢;班后尿中均检出2,5-己二酮;血清NSE水平测定,异常率为22.6%。结论接触超限值正己烷浓度对工人的神经系统症状体征、神经传导速度、2,5-己二酮以及血清NSE水平均有影响。