神经肌电图检查对糖尿病周围神经病变的诊断价值

目的：探讨电生理检查对糖尿病周围神经病变的早期诊断价值。方法：运用肌电诱发电位仪检测200例糖尿病患四肢运动神经传导速度（MCV），感觉神经传导速度（SCV）。结果：临床诊断为糖尿病周围神经病为127例，经肌电图检查增至184例，确诊率由63.5％上升到92.0％；在无症状的73例中经肌电诊断异常为57例，异常率为78.1％。结论：神经肌电图检查是糖尿病周围神经病早期诊断一种有价值的检查手段，可为糖尿病周围神经病临床疗效评估及治疗方案拟定提供重要依据。     

神经肌电图检查对糖尿病周围神经病变的诊断价值

目的:探讨电生理检查对糖尿病周围神经病变的早期诊断价值。方法:运用肌电诱发电位仪检测200例糖尿病患者四肢运动神经传导速度(MCV),感觉神经传导速度(SCV)。结果:临床诊断为糖尿病周围神经病为127例,经肌电图检查增至184例,确诊率由63.5%上升到92.0%;在无症状的73例中经肌电诊断异常为57例,异常率为78.1%。结论:神经肌电图检查是糖尿病周围神经病早期诊断一种有价值的检查手段,可为糖尿病周围神经病临床疗效评估及治疗方案拟定提供重要依据。     

神经传导速度测定对早期糖尿病周围神经病变的意义

目的:探讨神经传导速度(NCV)对糖尿病周围神经病(DPN)的诊断价值.方法:对100例无明显周围神经症状的糖尿病患者进行周围神经NCV的测定,同时行相关因素分析.结果:NCV可发现无明显周围神经病变的糖尿病患者部分周围神经呈损伤性改变,总异常率达25.33%,同时发现感觉神经传导速度(SCV)异常率高于运动神经传导速度(MCV),下肢异常率高于上肢,且NCV改变与病程有关,而与年龄无关.结论:NCV测定有助于早期发现糖尿病周围神经病变.     

神经传导速度测定与感觉阈值检测在糖尿病周围神经病诊断中的应用价值对比分析

目的:对比分析神经传导速度测定与感觉阈值检测在糖尿病周围神经病诊断中的应用价值。方法:选取我院在2015年3月-2016年7月收治的102例糖尿病患者作为本次的研究对象,将其按病情的不同分为观察组(有周围神经病症状,50例)与对照组(无周围神经病症状,52例)。给予两组患者进行感觉阈值检测、神经传导速度测定。结果:观察组患者的感觉阈值异常率以及神经传导速度异常率明显高于对照组(92.00%vs 48.08%,54.00%vs 17.31%,P0.05)。结论:感觉阈值检测和神经传导速度测定在糖尿病周围神经病诊断中各有优缺点,联合检测,能够为临床提供更为有效的诊断依据,对患者的确诊以及后续的治疗均有重要的意义,值得临床推广应用。     

糖尿病末梢神经炎的电生理研究

以往糖尿病的并发症的末梢神经炎诊断是依靠病人的主要症状(有肢体麻木或疼痛)以及末梢型感觉减退、深感觉障碍、踝反射消失等体征来诊断,缺乏客观量化指标。目前肌电图仪可以检测运动神经传导速度(ＮＣＶ),该项指标能够客观反映周围神经受损程度,为诊断提供了客观依据。我们对糖尿病人做ＮＣＶ的测定,探讨了神经电生理检查在早期发现亚临床末梢神经炎的可能性。同时也观察了糖尿病末梢神经炎病人ＮＣＶ异常率的情况与病程、糖化血红蛋白(ＧＨｂＡ１ｃ)及空腹血糖(Ｂ．Ｓ)之间关系,现将我们观察的５０例Ⅱ型糖尿病患者ＮＣＶ检查结果报告如…     

2型糖尿病58例神经传导速度测定结果分析

作者对 5 8例 2型糖尿病患者进行神经传导速度测定 (ＮＣＶ) ,探讨 2型糖尿病患者在临床症状出现之前的周围神经病变的发生情况及神经传导速度测定对周围神经病变的诊断价值 ,以提高对 2型糖尿病周围神经病变的认识。1　临床资料1 1　一般资料　所观察 5 8例均为 2型糖尿病住院     

糖尿病患者50例神经传导速度分析

多发性糖尿病性周围神经病是糖尿病性神经病中发生率最高的并发症,早期诊断、早期预防、及时治疗可获得较好的效果。为了解糖尿病(DM)患者周围神经电生理变化的规律和特点,以及与临床表现之间的关系,对DM患者50例进行神经传导速度测定,为临床的预防及治疗提供依据。     

亚临床2型糖尿病周围神经病变的电生理特点及诊断

目的研究亚临床2型糖尿病周围神经病变患者的神经电生理特点,为临床早期诊断该病提供参考数据。 方法对76例无周围神经系统症状及体征的2型糖尿病患者及30例健康者进行电生理检查,采用神经传导速度(NCV)检测患者周围运动及感觉神经功能,采用皮肤交感反应（SSR）和心率变异度（RRIV）检查自主神经功能。 结果本研究2型糖尿病患者联合电生理检查异常率为60.5%,其中纯感觉或纯运动神经异常率为2.6%,纯自主神经异常率为38.2%,两者均异常占19.7%;患者下肢神经病变程度较上肢严重;患者运动神经传导速度（MCV）及感觉神经传导速度（SCV）异常率均明显低于SSR和RRIV异常率;患者在平静呼吸时RRIV异常率为14.5%,深呼吸时为19.7%,有2例患者SSR正常、而RRIV异常。 结论联合采用NCV、SSR及RRIV检查能进一步提高亚临床2型糖尿病周围神经病变的早期诊断率。     

无神经系统症状2型糖尿病患者神经传导速度观察

目的:探讨神经传导速度对早期糖尿病周围神经痛的诊断价值.方法:应用肌电谤发电位仪检测100例无神经系统症状糖尿痛患者(糖尿病组)和50例健康成人(对照组)正中神经、尺神经、腓总神经、腓浅神经的神经传导速度.结果:糖尿病组神经传导速度低于对照组(P<0.05),神经传导速度异常率高于对照组(P<0.05).结论:神经传导速度检查可作为糖尿病早期周围神经病的检测手段之一.     

周围神经减压术治疗糖尿病性周围神经病的临床疗效观察

目的:探讨周围神经减压术治疗糖尿病性周围神经病的临床疗效.方法:应用腓总神经、腓深神经及胫后神经三处周围神经减压术治疗17例糖尿病性周围神经病患者,并回顾性分析其临床疗效.结果:患者术后疼痛缓解率为100%,麻木的缓解率为94.1%,神经传导速度明显改善.结论:周围神经减压术是治疗糖尿病性周围神经病的有效方法.     

Perioperative Peripheral Nerve Block Safety Education: A Quality Improvement Project

PurposeThe purpose of the quality improvement (QI) project was to improve patient safety by increasing the consistency of monitor application and oxygen administration during the placement of peripheral nerve blocks (PNBs), advance the knowledge of perianesthesia staff about PNB safety, and develop a PNB hospital policy.DesignQI project using the focus, analyze, develop, and execute model.MethodsThe project had two parts, an educational component that was deployed in the three hospitals (hospital A, hospital B, hospital C) and an observation component that was conducted in only one of the hospitals (hospital A). Baseline observation of monitor and oxygen application was recorded at hospital A for 3 months. Assessment of perioperative personnel's baseline knowledge regarding PNB safety was attained using a knowledge assessment tool in the three hospitals. Learners in the three hospitals were given a pretest and post-test to measure the change in knowledge level after a PNB safety presentation was given. Monitor and oxygen application during nerve block placements were observed and recorded after the PNB safety presentation at hospital A. Statistical analysis was completed to determine if significant differences in knowledge levels in the three hospitals and monitor and oxygen application at hospital A existed after an educational intervention was delivered to the perioperative teams.FindingsParticipants' knowledge level increased 13% overall with post-test scores greater than 90% after the educational intervention. Monitor application and administration of oxygen during PNB placement improved from 2% to 100% in a preliminary 3-week postintervention review. Systematic changes were implemented to facilitate adherence to best practice measures.ConclusionsPNB safety presentations significantly improved staff's knowledge regarding PNB procedures and potential problems. A multidisciplinary team approach was used to facilitate changes to improve electrocardiogram, blood pressure, pulse oximetry, and oxygen use in this patient population. A proposed PNB policy was accepted as a protocol. Patients are safer with increased monitoring.     

Ultrasound Elastographic Measurement of Sciatic Nerve Displacement and Shear Strain During Active and Passive Knee Extension

There is current need for objective measures of sciatic nerve mobility in patients with sciatic‐type pain. The objective of the study was to assess the feasibility and reliability of ultrasound elastography to quantify sciatic nerve displacement and shear strain at the sciatic nerve–hamstring muscle interface during active and passive knee extension‐flexion exercises performed while sitting in healthy people. Ultrasound elastography showed excellent intrarater within‐session reliability for assessing sciatic nerve displacement and sciatic nerve–hamstring muscle interface shear strain during active knee extension‐flexion exercises. These findings will inform similar future work conducted in patients with sciatic‐type pain.     

内源性神经营养因子促进冷冻保存大鼠坐骨神经异体移植后神经再生的作用

目的 探讨内源性神经营养因子(ENTFs)对冷冻保存大鼠坐骨神经同种异体移植后神经再生的影响。方法 15 mm雌性Sprague-Dawley大鼠坐骨神经置于DMEM溶液中,37 ℃、5% CO₂分别体外预处理1 d、3 d、7 d、14 d和21 d (A组、B组、C组、D组和E组),设置新鲜神经对照组(F组)。Western blotting检测神经的胶质细胞源性神经营养因子(GDNF)、神经生长因子(NGF)、Bcl-2、Bax、Caspase-3、主要组织相容性复合体(MHC)-Ⅰ、MHC-Ⅱ蛋白表达。将上述6组神经置于冷冻保存液中液氮保存4周,Calcein-AM/Propidium Iodide染色、激光共聚焦显微镜观察保存后神经活细胞和死细胞情况。用上述冷冻保存4周的坐骨神经和新鲜坐骨神经(G组),同种异体移植修复雌性Wistar大鼠坐骨神经10 mm缺损(A′组、B′组、C′组、D′组、E′组、F′组和G′组),设置同系移植组(H′组)。移植术后1周,免疫荧光染色观察CD₈⁺T细胞、巨噬细胞入侵移植物情况,ELISA法检测受者血清白细胞介素(IL)-2、干扰素(IFN)-γ、肿瘤坏死因子(TNF)-α水平;移植术后20周,电生理检测肌肉复合动作电位(CMAP)和神经传导速度(NCV),称重计算腓肠肌湿重比,神经丝(NF)200免疫荧光染色、甲苯胺蓝染色和透射电镜观察再生神经组织学。结果 与F组相比,C组、D组和E组GDNF、NGF蛋白表达均增加(P < 0.05);B~E组Bcl-2蛋白表达降低( P < 0.05),Bax和Caspase-3蛋白表达均增加( P < 0.05);A组~E组MHC-Ⅰ、MHC-Ⅱ蛋白表达均降低( P <0.05)。坐骨神经冷冻保存4周后,与F组和G组相比,C组、D组和E组活细胞数量降低。同种异体移植术后1周,与F′组和G′组相比,C′组、D′组和E′组移植物CD₈⁺T细胞、巨噬细胞减少,受者血清IL-2、TNF-α水平降低(P < 0.05)。移植术后20周,C′组、D′组和E′组CMAP、NCV、腓肠肌湿重比、再生有髓神经纤维数及髓鞘厚度均显著优于F′组和G′组( P <0.05),C′组、D′组和E′组移植神经NF200表达高于F′组和G′组。结论 体外预处理大鼠坐骨神经能诱导ENTFs表达,高表达ENTFs的坐骨神经冷冻保存后异体移植能促进受者神经再生和功能恢复。     

Low-frequency transcutaneous nerve stimulation in mild/moderate hypertension

Summary. Low-frequency peripheral nerve stimulation may induce widespread cutaneous and muscular vasodilatation in animals and humans due to sympatho-inhibition. This response has in humans been shown to be associated with a lowering of the systemic vascular resistance and arterial pressure. In the present study the effectiveness of low-frequency (2 Hz) transcutaneous electrical nerve stimulation (TNS) has been examined in 46 patients, all 41–43 years of age, with a primary diagnosis of uncomplicated mild/moderate hypertension (90–115 mmHg diastolic pressure). The study was designed blind with matched controls in a TNS group and a placebo group. The blood pressure was measured objectively with an automatic monitor. In a short-term experiment TNS produced a significant lowering of systolic, mean arterial, and diastolic pressures amounting to 8 mmHg (P<0·01), 6 mmHg (P<0·01), and 4 mmHg (P<0·02), respectively. In a long-term study, after 2 weeks of daily stimulation, a similar depression was recorded with no stimulation on the day of examination. An eventual clinical use of the depressor effect of TNS demands further clinical research.     

大鼠周围神经条件性损伤促进对侧神经再生

目的了解条件性损伤与神经再生的关系.方法50只雄性SD大鼠,按术式随机分成两组.A组显露左侧坐骨神经,不损伤.B组造成左侧坐骨神经挤压伤.于伤后5d,两组均造成右侧坐骨神经挤压伤.分别于术后0、1、3、5、7d行挤压反射试验,检测神经轴突再生的距离及组织学观察.结果试验组的初期延迟1.05d明显短于对照组的初期延迟1.70d(P<0.05).结论大鼠坐骨神经条件性损伤通过缩短再生延迟,而促进神经再生.     

颈部脊髓损伤对患者双下肢神经传导功能的影响

目的:观察颈部脊髓损伤(SCI)后双下肢周围神经传导功能的变化,并比较完全性颈部SCI和不完全性颈部SCI之间的差异。方法:分别检测20例完全性颈部SCI患者、20例不完全性颈部SCI患者以及20例正常成年男性的胫神经、腓总神经、腓肠神经、隐神经的神经传导潜伏期、波幅和传导速度。结果:(1)运动神经:完全性损伤组和不完全性损伤组的末端运动神经潜伏期(DML)延长、运动神经传导速度(MCV)降低,与正常组比较有显著性差异(P0.05),但其异常率都低于10%;完全性损伤组和不完全性损伤组的复合肌肉动作电位(CAMP)降低,与正常组比较有显著性差异(P0.05),其异常率都高于20%,且完全性损伤组CAMP异常率高于不完全性损伤组(P0.05)。(2)感觉神经:完全性损伤组和不完全性损伤组的感觉神经动作电位(SNAP)波幅降低、感觉神经传导速度(SNCV)降低,与正常组比较有显著性差异(P0.05),但其异常率为0。结论:颈部SCI患者双下肢运动神经存在轴索变性,完全性损伤比不完全性损伤更重,感觉神经无明显异常。     

合成材料神经导管与自体神经移植修复周围神经缺损的比较

背景：生物可降解材料制成的神经导管可在体内降解,避免出现的神经卡压等问题,因而受到越来越多的关注. 目的：比较自体神经移植与3种合成可生物降解材料神经导管在修复周围神经损伤的效果差异. 方法：通过电生理学检测,形态学观察等神经恢复效果评价方法,对比分析近年来常用的胶原神经导管、DL-乳酸-ε-己内酯神经导管、聚乙醇酸神经导管与自体神经移植修复周围神经缺损的效果. 结果与结论：虽然神经导管与自体神经移植相比在理论上有其优势的一面,但不同合成材料的神经导管之间在神经功能恢复中存在明显差异性,DL-乳酸-ε-己内酯神经导管修复效果与自体神经移植无明显差异,是较为理想的神经导管材料,聚乙醇酸神经导管因自身的因素影响其降解性能,在3种神经导管中的修复周围神经损伤效果最差,胶原神经导管需要交联剂改善其机械性能,其修复周围神经损伤效果居于前两者之间,因此,这3种神经导管在神经功能再生方面还有潜在的缺陷,不能完全替代自体神经移植,而且3者之间的性价比,还缺少足够的大样本长期随机对照实验结果来验证,还需要进一步的实验观察.     

血管内皮细胞联合同种异体神经移植修复长距离大鼠坐骨神经缺损

目的:探讨血管内皮细胞(EC)联合去细胞同种异体神经移植修复长距离大鼠坐骨神经缺损的效果。方法:80只雌性Sprague-Dawley大鼠,20只取双侧1.5cm长坐骨神经,Hudson优化法制备去细胞同种异体神经(ANA);60只均于右侧建立1.5cm长坐骨神经缺损模型,随机分为反转吻合坐骨神经的自体神经(ANG)移植组、ANA移植组及ANA+EC移植组(n=20)。术后1、2、4、12周,每组各取5只进行测试,指标包括:坐骨神经功能指数(SFI)、电生理检查[动作电位潜伏延迟率(LDR)、神经传导速度恢复率(NCVRR)和复合肌动作电位恢复率(CMAPRR)]、最大强直收缩力恢复率(MTFRR)、腓肠肌湿重恢复率(MWRR)、微血管增生率(MVDPR),术后12周甲苯胺蓝染色下测量神经纤维数量、髓鞘厚度、G ratio,并行电镜观察。结果:术后早期,ANA+EC移植组大鼠SFI、MVDPR较ANA移植组改善明显(P0.05);术后晚期,ANA+EC移植组大鼠CMAPRR、MTFRR、MWRR较ANA移植组恢复更佳(P0.05);术后12周时,ANA+EC移植组再生神经数量和形态更接近ANG移植组。结论:对于长距离坐骨神经缺损的大鼠模型,使用载血管内皮细胞的去细胞同种异体神经进行神经移植修复,早期肌肉功能优于单独使用去细胞同种异体神经,晚期神经纤维的数量和质量更接近于自体神经移植。     

尿毒症患者周围神经的电生理研究

目的研究尿毒症患者周围神经的电生理表现。方法选择尿毒症患者24 例及同期健康对照者19 例,采用常规表面电极对胫后神经、腓总神经、腓肠神经及皮肤交感反应进行检查,观察尿毒症患者周围神经的电生理表现。结果两组运动传导、感觉传导及交感皮肤反应潜伏期均有显著性差异(P<0.05)。电生理表现主要为F 波的潜伏期延长,传导速度减慢,潜伏期延长,感觉纤维受累重于运动纤维。结论尿毒症性周围神经病是尿毒症最常见的并发症之一,神经电生理的异常明显早于临床症状,周围神经的电生理检查对该病的诊断及评价具有重要意义。     

Analysis of human acellular nerve allograft reconstruction of 64 injured nerves in the hand and upper extremity: a 3 year follow‐up study

Human acellular nerve allografts have been increasingly applied in clinical practice. This study was undertaken to investigate the functional outcomes of nerve allograft reconstruction for nerve defects in the upper extremity. A total of 64 patients from 13 hospitals were available for this follow‐up study after nerve repair using human acellular nerve allografts. Sensory and motor recovery was examined according to the international standards for motor and sensory nerve recovery. Subgroup analysis and logistic regression analysis were conducted to identify the relationship between the known factors and the outcomes of nerve repair. Mean follow‐up time was 355 ± 158 (35–819) days; mean age was 35 ± 11 (14–68) years; average nerve gap length was 27 ± 13 (10–60) mm; no signs of infection, tissue rejection or extrusion were observed among the patients; 48/64 (75%) repaired nerves experienced meaningful recovery. Univariate analysis showed that site and gap length significantly influenced prognosis after nerve repair using nerve grafts. Delay had a marginally significant relationship with the outcome. A multivariate logistic regression model revealed that gap length was an independent predictor of nerve repair using human acellular nerve allografts. The results indicated that the human acellular nerve allograft facilitated safe and effective nerve reconstruction for nerve gaps 10–60 mm in length in the hand and upper extremity. Factors such as site and gap length had a statistically significant influence on the outcomes of nerve allograft reconstruction. Gap length was an independent predictor of nerve repair using human acellular nerve allografts. Copyright © 2016 John Wiley & Sons, Ltd.