无创经皮电刺激仪治疗OSAS的实验研究和临床疗效

研究采用经皮双向电流脉冲刺激舌下颏舌肌作为治疗阻塞性睡眠呼吸暂停综合征(O bstructive sleepapnea syndrom e,O SA S)的一种新方法。采用多导睡眠图同步监测患者,当发生睡眠呼吸暂停时及时给予最佳参数的电刺激,使得以颏舌肌为主的上气道扩张肌促使舌体向前运动,扩大舌咽气道,降低上气道阻力,改善夜间低氧血症,改善睡眠结构。临床疗效结果表明,22名O SA S患者经我们治疗后显效17名,好转2名,无效3名,有效率77.27%。初步证明这是一种的治疗O SA S的新方法。     

经皮电刺激治疗阻塞性睡眠呼吸暂停综合征的研究

目的：采用经皮无创的双向电流脉冲刺激舌下颏舌肌，研究这种方法作为治疗阻塞性睡眠呼吸暂停综合征的可能性和适用性。方法：采用PSG同步监测，根据患者不同的情况，分析给出最佳的电刺激参数，当发生睡眠呼吸暂停时及时给予适当的电刺激信号，以颏舌肌为主的上气道扩张肌使舌体向前运动，扩大舌咽气道，从而降低上气道阻力，改善夜间低氧血症，使睡眠结构得以改善，达到治疗目的。结果：对22名阻塞性睡眠呼吸暂停综合征患者给予经皮无创电刺激舌下神经分支，经治疗后显效17名，好转2名，无效3名，有效率77．27％。结论：这是一种非手术的、有临床价值的、低费用的治疗阻塞性睡眠呼吸暂停综合征的方法。     

五音乐曲对精神分裂症脑电活动率的影响

目的 :观察五音乐曲刺激对精神分裂症患者脑电活动产生的影响。方法 :选取 2 0例精神分裂症患者和 10名正常对照 ,分别记录安静时段及聆听五音乐曲时段的脑电图 ,将脑电信号转化为功率数值 ,将 β/α定义为脑电活动率。 结果 :1、正常人与精神分裂症患者的脑电活动率在安静状态差异无显著性 (P >0 0 5 )。在听乐曲时患者的脑电活动率在C3、T3、T4、T5导联中 ,明显高于正常人 (P <0 0 5 )。 2、正常人在安静状态和听乐曲时其左右脑脑电活动率差异无显著性 (P >0 0 5 )。精神分裂症患者在安静状态左右脑脑电活动率在O1、O2及T5、T6导联间差异有显著意义 (P <0 0 5 ) ,并且听乐曲时在P3、P4和C3、C4以及F7、F8导联间差异有显著意义 (P <0 0 5 )。结论 :在五音乐曲的刺激下 ,精神分裂症患者的脑电反应与正常人不同。     

舌下神经舌骨舌肌段的应用解剖

本文用１６具成人尸体，１０％福尔马林固定，红色乳胶股动脉灌注，在手术显微镜下解剖舌下神经舌骨舌肌段的分支及其毗邻结构。该段舌下神经上方有舌神经及其伴行静脉、下颌下腺导管、下颌下腺深部；下缘有舌下神经伴行静脉；舌下神经向上、向前、向下均有分支，分别到达茎突舌肌、舌骨舌肌、颏舌肌、甲状舌骨肌、颏舌骨肌。讨论了这些结构的临床意义。     

自动递增刺激记录大鱼际肌运动单位估数及其可重复性

目的 :建立自动递增刺激记录正中神经支配的大鱼际肌运动单位估数 (motorunitnumberestimation ,MUNE)正常值并研究其与年龄、性别的关系和该技术的重复性。方法 :用自动递增刺激记录技术估测正中神经支配的大鱼际肌运动单位数 ,检测无神经肌肉病变的正常人 6 0名 ,年龄 2 0～ 88岁 ,平均 5 0 33± 2 0 81岁。结果 :①正常人正中神经支配的大鱼际肌MUNE为 30 0± 83个 ,三个年龄组的MUNE分别为 35 3± 6 3个 (2 0～ 39岁 )、32 2± 5 4个 (4 0～ 5 9岁 )、2 16± 5 9个 (6 0～ 88岁 ) ;②正常人大鱼际肌MUNE与年龄呈负相关 ,与性别无关 ,6 0岁以上组大鱼际肌MUNE比 6 0岁以下各组明显减少 (P <0 0 0 1) ;③大鱼际肌MUNE重复性实验两次检查值相差不显著 (P =0 3)。结论 :自动递增刺激记录正中神经支配的大鱼际肌MUNE为 30 0± 83个 ,随年龄的增大持续性下降 ,特别在 6 0岁后运动单位数下降明显 ,运动单位估数应考虑年龄因素。大鱼际肌MUNE有良好的可靠性和重复性 ,与性别无关。     

丙烷盐酸盐对自发性高血压大鼠和正常血压大鼠心肌跨膜电活动的影响

目的与方法 :采用细胞内玻璃微电极技术 ,研究 1- (2 ,6 -二甲基苯氧基 ) - 2 - (3,4-二甲氧基苯乙氨基 )丙烷盐酸盐 (DDPH)对自发性高血压大鼠 (spontaneouslyhypertensiverat,SHR)与正常血压大鼠 (Wistar)离体左心室乳头状肌和左心房肌细胞跨膜电位的影响。结果 :①给药前 ,SHR大鼠心室肌细胞动作电位复极5 0 % (APD50 )和 90 % (APD90 )时程明显较正常血压大鼠延长。②DDPH(5～ 5 0 μmol·L-1)呈浓度依赖性抑制SHR左心室细胞Vmax降低动作电位振幅 (APA) ,延长APD90 和APD50 ,并可明显抑制右心房自发性电活动的频率 ,但对静息膜电位 (RP)无明显的作用。对正常血压大鼠 ,DDPH呈类似的作用。结论 :在相同的浓度作用下 ,DDPH抑制SHR左心室肌细胞Vmax与右心房自发性电活动的频率作用较正常血压大鼠显著 ,在SHR左心房肌细胞 ,DDPH(5 0 μmol·L-1)延长APD50 的作用较正常血压大鼠显著 ,对Vmax、APA和APD90 作用两种大鼠无明显的差别。     

肌电假肢实用化问题探讨

本文就下列肌电控制假肢实用化问题进行探讨:(1)肌电控制信号的测试标准及其定量指标制定;(2)康复肌电的方法与应用实例;(3)适用于过短残肢的肌电假手研制。     

舌肌肌电图对运动神经元病诊断价值探讨

目的:探讨舌肌肌电图(EMG)对运动神经元病(MND)的诊断价值。方法:对22例 MND患者[其中肌萎缩侧索硬化(ALS)13例,脊肌萎缩症(SMA)9例]进行常规EMG及胸锁乳突肌和舌肌EMG检查,并比较其结果。结果:MND患者EMG舌肌纤颤电位阳性率为59％,而临床表现舌肌纤颤仅32％,EMG敏感性高于临床表现,但经统计学分析差异不明显。ALS与SMA两组常规EMG 比较无明显差异。ALS组舌肌EMG纤颤电位62％(8／13例),胸锁乳突肌纤颤电位39％(5／13例),两者比较差异无统计学意义,但SMA组舌肌纤颤电位阳性率为56％(5／9),胸锁乳突肌EMG无纤颤电位,两者比较差异有统计学意义(P<0.05)。结论:舌肌EMG可作为诊断运动神经元病重要的辅助手段,其诊断价值高于胸锁乳突肌EMG,尤其对SMA病例,与胸锁乳突肌EMG相结合则诊断价值更大。     

帕金森氏病病人丘脑底核的电生理特性及深部脑刺激的研究

目的　研究帕金森氏病 (PD)病人丘脑底核 (STN)的电生理特性及深部脑刺激 (DBS)对PD的治疗作用 ,观察术中STN电刺激对PD病人的震颤、肌僵直、运动缓慢的缓解及对语言感觉的影响。方法　在 2 6例立体定向术治疗PD手术中 ,应用美国FHC公司生产的微电极记录系统 ,记录病人STN不同部位的放电形式 ;并在MRI和微电极导向下 ,将刺激电极植入STN ,进行刺激实验 ;高频刺激参数的频率是 1 50Hz,脉宽 1 50ms,强度自 0 .5V开始 ,逐渐增加至6～ 8V ;其中 2例进行了STN的永久性DBS ,术后分别随访 1 4个月和 1 8个月。结果　微电极进入STN ,可记录到一致的、稳定的高频放电〔8～ 1 0V、(96± 1 6)Hz〕 ;术中刺激发现 ,在最佳点位刺激 ,病人的震颤、肌僵直、运动缓慢均得到明显改善 ,1 1例病人 (42 % )在刺激强度增加到 4～ 6V以上时 ,有语言障碍。结论　微电极记录获得STN的电生理放电特征 ,可以提高立体定向治疗PD的靶点精确性 ,提高疗效 ;STN的高频刺激能改善PD的震颤、肌僵直、运动缓慢等主要症状 ,是DBS治疗PD的最佳靶点之一。     

睡眠中上呼吸道与呼吸肌电流图及脑电图的定量分析

在研究睡眠对呼吸的影响及睡眠引起的呼吸紊乱时,定量的上呼吸道与呼吸肌活动可提供解释睡眠引起的微量换气变化及呼吸系统力学的重要信息。我们用插入口腔的双极针电极记录了颏舌肌的活动,并用胃食管引管记录了膈肌活动。睡眠状态由脑电图监测。两肌的电活动经放大、频带移动(30Hz与600Hz之间),校正和平均(对相邻200ms间隔),提供了肌电活动的“移动时间平均”测量。同样,为了获得连续的“状态参数”,一个5秒钟的时间窗口以1.25秒的增量移过各脑电图波形并计算出了各增量的功率谱。对各谱导出了0.5～1.0c/s之间的总功率,从而提供了状态参数函数的     

Electrically evoked myoelectric signals.

Electrical stimulation of the nervous system is attracting increasing attention because of the possibilities it offers for physiological investigations, clinical diagnosis, muscle function assessment, noninvasive muscle characterization, and functional control of paralyzed extremities. Parameters of the myoelectric signal evoked by surface stimulation of a muscle motor point or by stimulation of a nerve trunk by means of implanted electrodes provide information about muscle performance and properties if the stimulation artifact is properly removed or suppressed. Comparison of these parameters with those obtained during voluntary contractions provides additional insight into muscle physiology. The relationships between myoelectric signal amplitude parameters, spectral parameters, and conduction velocity are discussed with special reference to muscle fatigue. This review focuses on a few methodological aspects concerning electrical stimulation of the peripheral nervous system, detection, and processing of the electrically evoked myoelectric signals in skeletal muscles. The state of the art of the following issues is discussed: (1) properties of voluntary and electrically evoked myoelectric signals; (2) techniques for evoking and detecting myoelectric signals; (3) techniques for suppression of stimulation artifacts; (4) effect of stimulation waveforms and electrode properties; (5) signal processing techniques for electrically evoked myoelectric signals; (6) physiological significance of myoelectric signal variables; (7) order of recruitment of motor units during electrical stimulation; (8) myoelectric manifestations of fatigue in electrically stimulated muscles; (9) assessment of crosstalk by electrical stimulation; and (10) applications in sport, rehabilitation, and geriatric medicine.     

Electrical stimulation and myoelectric control. A theoretical and applied study relevant to prosthesis sensory feedback

Electrical nerve stimulation applied to an amputation stump to convey sensory feedback from a myoelectric hand prosthesis inevitably interferes with the prosthesis control system. The intention of this study is to investigate the extent of the interference to allow the implementation of a self-contained myoelectric prosthesis with electrical nerve stimulation feedback. The interference voltage sensed by two types of e.m.g. pick-up electrode units is studied as a function of the distance between the stimulating electrodes and the pick-up electrode units. Results obtained from experiments performed on human subjects andin vitro are supported by results based on electrical field theory. It is concluded that electrical nerve stimulation for prosthesis sensory feedback can be used close enough to myoelectric control systems to be in accordance with the principle of prothesis self-containment.     

Mechanical effects of genioglossus muscle stimulation on the pharyngeal airway by MRI in cats

To examine the regional mechanical effects of selective genioglossus muscle activation on pharyngeal airway size and function, magnetic resonance images of the pharyngeal airway were obtained in five paralyzed, anesthetized cats over a range of positive and negative pressures in an isolated, sealed upper airway. When all results across pressure levels and pharyngeal regions were analyzed, genioglossus stimulation significantly increased the cross-sectional area (CSA) of the nasopharyngeal airway. Within specific regions, stimulation tended toward significantly increasing cross-sectional airway area in the mid-nasopharynx. Despite its dilating effect, genioglossus muscle stimulation did not alter compliance in the nasopharyngeal airway, as evidenced by the similar slopes of the pressure versus cross-sectional area relationships with and without stimulation. Finally, airway shape in the mid pharynx became more circular with either increased airway pressure or genioglossus stimulation. The results indicate that selective stimulation of the genioglossus muscle dilates the nasopharynx and provide evidence that stimulation of the genioglossus alone does not alter airway compliance.     

Suppression of genioglossus muscle tone and activity during reflex hypercapnic stimulation by GABA(A) mechanisms at the hypoglossal motor nucleus in vivo

The genioglossus muscle is involved in the maintenance of an open airway for effective breathing. Inhibitory neurotransmitters may be responsible for the major suppression of hypoglossal motor output to genioglossus muscle that occurs in certain behaviours such as rapid-eye-movement sleep. There is evidence for GABA(A) receptor-mediated inhibition of hypoglossal motoneurons in vitro. However, comparable studies have not been performed in vivo and the interactions of such mechanisms with integrative reflex respiratory control have also not been determined. Urethane-anaesthetised, tracheotomized and vagotomized rats were studied whilst diaphragm and genioglossus muscle activities, blood pressure and the electroencephalogram were recorded. Microdialysis probes were implanted into the hypoglossal motor nucleus, with sites verified by histology. Genioglossus responses to microdialysis perfusion of muscimol (GABA(A) agonist: 0, 0.1, 1 and 10 microM in artificial cerebrospinal fluid) were recorded at inspired CO(2)s of 0, 5 and 7.5% in six rats. Responses to bicuculline (GABA(A) antagonist, 0, 1, 10, 100 and 1000 microM) were also studied in six rats with and without CO(2) stimulation. Genioglossus activity decreased with muscimol (P<0.0001), with major suppression at 1 and 10 microM during air breathing (decreases=70.2% and 92.8%, P<0.005). Genioglossus activity increased with CO(2) (P=0.003), but genioglossus activation with 5 and 7.5% CO(2) were almost abolished with 10-microM muscimol. Responses were specific to genioglossus muscle as there were no changes in diaphragm, respiratory rate or blood pressure with muscimol (P>0.144). Antagonism of GABA(A) receptors increased genioglossus activity (P<0.001). These results show that GABA(A) receptor stimulation at the hypoglossal motor nucleus suppresses both genioglossus muscle tone and activity in the presence of reflex stimulation produced by hypercapnia. Recruitment of such mechanisms may contribute to the major suppression of genioglossus activity observed with and without CO(2) stimulation in behaviours such as rapid-eye-movement sleep.     

Modelling myoelectric interference patterns during movement

Interpretation of myoelectric interference patterns during movement relies on suitably formulated models. In the review, various modelling approaches are described and discussed. The importance of incorporating the time lag between mechanical and electrical activities in models of myoelectric activity is underlined. It is suggested that a portion of electrical activity is not related to force production but represents muscle efforts at damping oscillations in the surrounding soft tissues.     

Interaction between genioglossus and diaphragm responses to transcranial magnetic stimulation in awake humans

The modulation of activity of the upper airway dilator and respiratory muscles plays a key role in the regulation of ventilation, but little is known about the link between their neuromuscular activation processes in vivo. This study investigated genioglossus and diaphragm responses to transcranial magnetic stimulation applied in different facilitatory conditions. The amplitude and latency of motor-evoked potential responses and the stimulation intensity threshold leading to a motor response (motor threshold) were recorded with stimulation applied at the vertex and anterolateral area in 13 awake normal subjects. Stimuli were applied during inspiration with and without resistance, during expiration with and without maximal tongue protrusion and during deep inspiration. In each stimulation location and condition, no diaphragmatic response was obtained without previous genioglossus activity (diaphragmatic and genioglossus responses latencies during expiration: 18.1 +/- 2.9 and 6.3 +/- 2.6 ms, respectively, mean +/- s.d., P < 0.01). Genioglossus motor-evoked potential amplitude, latency and motor threshold were significantly modified with tongue protrusion with a maximal effect observed for stimulation in the anterolateral area. Deep inspiration was associated with a significant facilitatory effect on both genioglossus and diaphragm motor responses. The facilitatory effects of respiratory and non-respiratory manoeuvres were also observed during focal stimulation where isolated genioglossus responses were observed. Genioglossus and diaphragm differed in their motor threshold both at baseline and following facilitatory manoeuvres. Conclusions: (1) transcranial magnetic stimulation-induced genioglossus response systematically precedes that of diaphragm; (2) this sequence of activation is not modified by respiratory and non-respiratory manoeuvres; and (3) the genioglossus and diaphragm are differently influenced by these manoeuvres in terms of latency of the motor response and of motor threshold.     

Noxious lingual stimulation influences the excitability of the face primary motor cerebral cortex (face MI) in the rat

The mechanisms whereby orofacial pain affects motor function are poorly understood. The aims were to determine whether 1) lingual algesic chemical stimulation affected face primary motor cerebral cortex (face MI) excitability defined by intracortical microstimulation (ICMS); and 2) any such effects were limited to the motor efferent MI zones driving muscles in the vicinity of the noxious stimulus. Ketamine-anesthetized Sprague-Dawley male rats were implanted with electromyographic (EMG) electrodes into anterior digastric, masseter, and genioglossus muscles. In 38 rats, three microelectrodes were located in left face MI at ICMS-defined sites for evoking digastric and/or genioglossus responses. ICMS thresholds for evoking EMG activity from each site were determined every 15 min for 1 h, then the right anterior tongue was infused (20 mul, 120 mul/h) with glutamate (1.0 M, n = 18) or isotonic saline (n = 7). Subsequently, ICMS thresholds were determined every 15 min for 4 h. In intact control rats (n = 13), ICMS thresholds were recorded over 5 h. Only left and right genioglossus ICMS thresholds were significantly increased (相似文献   

Organization of the cerebellar tongue representation in the monkey

Summary The cerebellar nuclei of rhesus monkeys were stimulated electrically and evoked responses of the tongue recorded with force-displacement transducers and electromyographically. Stimulation of the dentate (DN) and fastigial (FN) nuclei produced different effects on the tongue musculature, the former evoking movements characterized by changes in both the lateral and anteroposterior (AP) dimensions of the tongue and the latter movements associated with a preferential change in the AP dimension. While all three deep nuclei influenced the genioglossus muscle, the influences varied across nuclei in the following manner: FN produced the largest amplitude genioglossus mediated AP excursions and DN the smallest, with the nucleus interpositus (NI) occupying an intermediate position; and, FN and medial NI stimulation evoked changes in genioglossus respiratory activity whereas DN stimulation did not. These data indicate that the cerebellar tongue representation is organized into different functional zones and that within an anatomically broad representation of a single target muscle, nuclear functional specificity exists.     

Advances in processing of surface myoelectric signals: Part 1

During sustained voluntary or electrically elicted muscle contractions the surface myoelectric signal is nonstationary and it undergoes progressive changes reflecting the modifications of the motor unit action potentials and their propagation velocity. In particular, during sustained electrical stimulation, the evoked signals show progressive amplitude, time scaling and shape modification. The quantitative evaluation of these changes is important for non-invasive muscle characterisation and may be performed in either the time or frequency domain using parametric and nonparametric spectral analysis as well as alternative methodologies. The paper introduces the detection techniques, reviews and compares the methods of spectral estimation based on FFT and autoregressive models, and discusses their applications and limitations in extracting information from the surface myoelectric signal with particular regard to myoelectric manifestations of localised muscle fatigue during sustained contractions.