重复频率电刺激对儿童重症肌无力的诊断价值

目的：研究重复频率电刺激（RNS）在儿童重症肌无力（MG）诊断中的价值。方法：对67例儿童MG患儿分别进行面、腋、尺神经的低频RNS，并对结果进行分析。结果：67例MG患儿中属眼肌型（Ⅰ型，最轻型）50例RNS检测结果阳性率为58％～75％；属于全身型（Ⅱ型）17例RNS检测结果阳性率达100％。结论：MG患儿RNS检测结果与临床病情的严重程度呈正相关。     

重症肌无力的临床分型与其重复电刺激的检测

目的：探讨不同类型重症肌无力（MG）患者的重复电刺激（RNS）检测的异常率与临床绝对评分的相关性。方法：对66例初次发病MG患者按Osserman临床分型进行临床绝对评分，对不同部位进行低频RNS检测，并分析其结果与临床的相关性。结果：MG患者面神经、腋神经、尺神经RNS阳性率分别为55％、71％、27％，MG患者腋神经的RNS平均异常率与临床绝对评分呈正相关（P％0．05）。结论：MG患者腋神经的RNS异常率可反映MG病情的严重程度。     

重症肌无力的重复神经刺激检查研究

目的：研究重复神经刺激（ＲＮＳ）检查对重症肌无力（ＭＧ）疾病的诊断价值。方法：对４４例ＭＧ患者进行重复神经刺激检查,共检查１３２条神经。结果：ＭＧ患者１３２条神经ＲＮＳ诱发的波幅衰减阳性率６５２％。受检的三组肌肉中三角肌阳性率最高（８４１％）,测量波面积对ＭＧ的诊断价值优于测量波幅,两种测量方法阳性率比较有显著性差异（Ｐ＜００５）。ＲＮＳ阳性的ＭＧ患者１００％的在低频刺激时即可获得阳性结果,波幅衰减最明显的刺激频率为５Ｈｚ。结论：ＲＮＳ检查在ＭＧ疾病诊断中具有重要价值     

重复电刺激检查在神经肌肉接头病变诊断中的临床应用研究

目的：研究神经重复电刺激检查对神经肌肉接头病变的诊断价值。方法：用Ｎｅｕｒｏｍａｔｉｃ型２０００Ｃ及Ｋｅｙｐｏｉｎｔ型肌电图／诱发电位仪，检查９３例神经科肌无力患者１８８条神经的重复电刺激，按临床诊断分为重症肌无力（ＭＧ）组（ｎ＝５９）和非重症肌无力（ｎＭＧ）组（ｎ＝３４）。结果：ＭＧ组神经重复电刺激诱发的波幅衰减阳性率（６４％）显著高于ｎＭＧ组（８８％）（Ｐ＜０００５）。９７５％的ＭＧ患者在低频刺激时即可获得阳性结果，波幅衰减最大的刺激频率为５Ｈｚ而非３Ｈｚ。测量波面积对ＭＧ的诊断价值优于测定波幅。结论：神经重复电刺激检查在神经肌肉接头病变的诊断中具有重要价值     

39例分娩性臂丛神经损伤新生儿的神经电生理评价

目的:探讨新生儿期电生理检测在评价分娩性臂丛神经损伤中的价值。方法:应用肌电一诱发电位仪对39例分娩性臂丛神经损伤新生儿进行检测。测试项目包括:①患侧臂丛神经五大分支腋神经、肌皮神经、正中神经、尺神经及桡神经运动神经传导速度测定;患侧正中神经、尺神经及桡神经感觉神经传导速度测定;②采用同芯针电极检测臂丛神经支配远端肌肉(三角肌、肱二头肌、4伸指总肌、外展拇短肌、外展小指肌或骨问肌)肌电图。结果:39例新生儿中全臂丛神经损伤11例(28％);上干损伤18例(46％);下干损伤3例(8％);后束损伤7例(18％)。节前损伤11例(28％)。结论:新生儿期神经电生理检测对早期评价分娩性臂丛神经损伤的范围、性质、部位及程度具有重要的临床价值。     

尺神经的血供

在20具(男10,女10)科研用成人尸体上,经动脉灌注带色乳胶液,在SXP-1型手术显微镜下解剖和观察了40侧尺神经的营养动脉及其来源动脉。共发现348支营养动脉,平均值为8.7±0.38(5-14)支。营养动脉的外径平均值为0.33±0.05(0.2-0.6)mm。营养动脉的来源:腋段来自腋动脉(15)和胸外侧动脉(2支);臂段来自尺侧上副动脉(105支)和肱动脉肱三头肌支(3支);前臂段来自尺侧返动脉(32支)、尺动脉(143支)和尺动脉尺侧(?)屈肌支(18支)。本文认为,在外伤性截肢或颈8,胸1脊神经根节前撕脱伤病人,可以尺侧上副动脉为蒂进行尺神经游离移植。     

环指感觉神经传导速度检测对诊断轻度腕管综合征的价值

目的：探讨环指感觉神经传导速度（SCV）测定对诊断轻度腕管综合征（CTS）的敏感性。方法：临床症状体征符合CTS,正中神经运动末端潜伏期正常的59例（62手）患者和50名（100手）年龄性别相匹配的健康对照参与本研究,采用顺向SCV测定法分别测定环指（指4）正中神经和尺神经SCV,指3正中神经SCV。结果：指4尺神经SCV〉46．6m／s,指4正中神经SCV〈44．6m／s,和（或）尺神经SCV与正中神经SCV差值〉8．1m／s（x＋2s）,符合CTS。正中神经SCV指3测定阳性率为70％,指4测定阳性率为82％,指4正中神经与尺神经SCV差值阳性率为96％。指4刺激可在29例（48手）患者腕部正中神经处记录到双峰电位,对照组未见。结论：比较指4正中神经和尺神经SCV的差值在鉴别轻度CTS方面是一个非常敏感的方法,腕部正中神经处记录到双峰电位是CTS确诊的明确指标。     

MEP、NCV、FW在突眼性甲状腺肿中的应用

目的:了解突眼性甲状腺肿患者感觉传入神经以及运动传出通路(包括运动中枢、脊髓、神经根和远、近端周围神经)的功能状态。方法:对44例突眼性甲状腺肿患者采用表面电极法常规顺向检测正中神经和胫后神经共88条神经感觉传导速度(SCV)、运动末端潜伏期(DL)及波幅,F波(FW)潜伏期及出现率。并在88条尺神经和腓总神经从中枢至外周传出通路不同部位予以磁刺激,分别在小指展肌和胫前肌记录复合肌肉动作电位,分别测定各段潜伏期和中枢运动传导时间(CMCT)。结果:88条正中神经和胫后神经中有16条(18%)SCV减慢或波幅降低,12条(14%)ML延长或波幅降低。4条FW潜伏期延长,4条FW出现率降低。88条尺神经和腓总神经运动诱发电位(MEP)检查中有34条(39%)波幅降低,各节段潜伏期和CMCT均未见异常。结论:NCV、FW、MEP联合检测对判断突眼性甲状腺肿是否合并神经病变具有较重要作用。     

电生理检查对伸指功能障碍的诊断价值

目的:探讨电生理检查对无明确外伤史出现伸指功能障碍的诊断价值。方法:对85例(92侧)无明确外伤史以伸指功能障碍为主诉的患者,桡浅神经、前臂内侧皮神经、尺神经、正中神经感觉神经传导速度(sensory nerve conduction velocity,SNCV)检测、运动神经传导速度(motor nerve conduction velocity,MNCV)检测;桡神经、正中神经、尺神经、肌皮神经、腋神经所支配肌的肌电图(electromyogram,EMG)检测。结果:外侧肌间隔卡压16例(16侧)、骨间后神经卡压41例(41侧)、胸廓出口14例(15侧)、运动神经元疾病4例(8侧)、平山病5例(7侧)、3例(侧)周围神经病变,2例(4侧)所检测指标均在正常范围,电生理检测所得结果阳性率为94.1%。结论:电生理检查可以对无明确外伤史出现伸指功能障碍提供客观的检测指标,对该病的病因诊断具有重要的价值。     

肱动脉变异1例

男尸,约60岁,右侧腋动脉形成2条等粗动脉,外径4．5mm,一条在正中神经的2条根部的后方走行,沿途发出分支伴桡神经进入桡神经沟,主干伴尺神经下行;另一条(肱副动脉)在前方下行至前臂,在桡骨颈延续为桡动脉和尺动脉。正中神经先在肱副动脉外侧下行,再从动脉后方绕至动脉内侧下行。     

A comparative study of single fiber electromyography and repetitive nerve stimulation in consecutive patients with myasthenia gravis

AIM: To compare the diagnostic yield of single fiber electromyography (SFEMG) and repetitive nerve stimulation (RNS) in consecutive patients with myasthenia gravis (MG). METHODS: Consecutive 33 patients with MG diagnosed on the basis of clinical features, positive neostigmine test and/or acetylcholine receptor antibody assay were categorized into stage 1 (3), 2A (10), 2B (12) and 2C (8 patients). Low rate repetitive nerve stimulation (3Hz) was performed in distal muscles (abductor digiti minimi, anconeus, flexor carpi ulnaris, tibialis anterior) and proximal muscles (deltoid, serratus anterior, trapezius and nasalis). Decrement exceeding 10% was considered abnormal. Single fiber EMG was performed in extensor digitorum communis (EDC), recording 20 potential pairs. The abnormality was defined as mean jitter exceeding 40 micros or 10% of potential pairs having block or jitter exceeding 54 micros. The abnormality in RNS and SFEMG was compared and correlated with severity of MG. RESULTS: RNS study was carried out in 33 and SFEMG in 30 patients. In 2 patients SFEMG was not possible due to lack of cooperation and in one due to severe weakness. The RNS study was normal in 6 (2 in stage 1, 3 in 2A and 1 in 2B) patients and in all of them SFEMG was abnormal. The abnormality in RNS and SFEMG correlated with severity of MG. CONCLUSION: SFEMG is indicated in the patients with MG in whom RNS test is negative.     

肌萎缩侧索硬化患者重复神经电刺激的观察

目的：观察肌萎缩侧索硬化（ALS）患者重复神经电刺激（RNS）时复合肌肉动作电位（CMAP）波幅衰减和递增的特点及意义。方法：对确诊的42例ALS患者与42例重症肌无力（MG）患者的尺神经3Hz（低频）与15Hz（高频）RNs的结果进行比较。结果：42例ALS患者中,低频RNS有明确衰减者30例,无明确衰减或递增者12例;高频RNS有明确衰减者4例,明确递增者22例,无明确衰减或递增者16例。以上结果均与以作对照的MG组比较,差异均有统计学意义（P〈0．05）。结论：ALS患者存在神经肌肉传递障碍,RNS衰减或递增可能与突触前机制有关,或许与突触前、后均受损害有关,RNS结果异常是病情活跃的标志,确切意义有待进一步探讨。     

颞骨原发性恶性肿瘤颅神经侵犯的CT与MR影像学评估

目的 探讨颞骨原发恶性肿瘤颅神经侵犯的CT与MR影像学表现。方法 回顾性分析2010年1月-2018年12月中山大学附属第一医院颞骨原发性恶性肿瘤中合并颅神经侵犯的23例患者的CT、MR影像学资料。其中男15例、女8例,年龄3~80岁;出现颅神经功能障碍17例,包括面神经受累症状者15例,外展神经功能障碍者2例。观察颞骨恶性肿瘤神经侵犯的部位、神经根穿行孔道及神经根的形态、信号及强化等颅神经受侵的CT、MR表现,及其与临床症状、手术病理结果的关系。结果 CT、MRI显示颅神经受侵23例,其中面神经受侵22例,三叉神经受侵5例,展神经、舌咽神经、迷走神经受侵各2例,听神经、副神经、舌下神经受侵各1例。颅神经受侵征象:CT显示面神经管扩大破坏22例,圆孔、卵圆孔骨壁、岩尖三叉神经压迹破坏各2例,颈静脉孔、舌下神经管破坏各1例;MRI显示颅神经增粗、强化8例,神经根干与周围软组织强化影紧贴但未完全包绕3例,神经被肿瘤包绕14例。23例CT、MRI显示的神经受侵患者中出现相应神经症状者17例,占73.9%。同时行CT及MRI检查的16例患者中,CT和MRI影像显示的受累神经分别为19、23根,CT、MRI诊断与临床手术病理一致分别为18、22根,其诊断符合率分别为81.8%(18/22)、95.7%(22/23)。结论 颞骨恶性肿瘤容易出现颅神经侵犯,且以面神经受侵最常见。颅神经受侵CT表现为神经穿行孔道破坏,MRI可直接显示神经增粗、异常强化,神经紧贴软组织影或神经直接被肿瘤包绕。结合CT和MRI的影像评估可以全面精准显示颅神经浸润情况,且MR较CT更为灵敏。     

The otic ganglion in rats and its parotid connection: cholinergic pathways, reflex secretion and a secretory role for the facial nerve

Otic ganglionectomy in rats was found to have affected the parotid gland more profoundly than section of the auriculotemporal nerve as assesssed by reduction in gland weight (by 33 versus 20%) and total acetylcholine synthesizing capacity (by 88 versus 76%) 1 week postoperatively and, when assessed on the day of surgery under adrenoceptor blockade, by reflex secretion (by 99 versus 88%). The facial nerve contributed to the acetylcholine synthesizing capacity of the gland. Section of the nerve only, at the level of the stylomastoid foramen, reduced the acetylcholine synthesis by 15% and, combined with otic ganglionectomy, by 98% or, combined with section of the auriculotemporal nerve, by 82%. The facial nerve was secretory to the gland, and the response was of a cholinergic nature. The nerve conveyed reflex secretion of saliva and caused secretion of saliva upon stimulation. Most of the facial secretory nerve fibres originated from the otic ganglion, since after otic ganglionectomy (and allowing for nerve degeneration) the secretory response to facial nerve stimulation was markedly reduced (from 23 to 4 μl (5 min)⁻¹). The persisting secetory response after otic ganglionectomy, exaggerated due to sensitization, and the residual acetylcholine synthesizing capacity (mainly depending on the facial nerve) showed that a minor proportion of pre- and postganglionic nerve fibres relay outside the otic ganglion. The great auricular nerve, which like the facial nerve penetrates the gland, caused no secretion of saliva upon stimulation. Avulsion of the auriculotemporal nerve was more effective than otic ganglionectomy in reducing the acetylcholine synthesizing capacity (by 94 versus 88%) and as effective as otic ganglionectomy in abolishing reflex secretion (by 99%). When aiming at parasympathetic denervation, avulsion may be the preferable choice, since it is technically easier to perform than otic ganglionectomy.     

三维重T2加权快速自旋回波成像技术对鉴别良恶性腮腺肿瘤的应用价值

目的 探讨MR 三维重T₂加权可变翻转角快速自旋回波(T₂-SPACE)成像技术在腮腺良恶性肿瘤鉴别诊断中的应用价值。方法 选取2015年6月—2017年12月宁波市第二医院收治的51例腮腺肿瘤患者进行前瞻性研究。其中男23例,女28例;年龄16～74岁。51例腮腺肿瘤患者均进行常规MR序列扫描和重T₂-SPACE序列扫描,将采集图像信息进行三维多平面重建后处理,并进行面神经和腮腺导管曲面重建。在重T₂-SPACE图像上观察腮腺肿瘤的位置、形态、边界、囊变坏死等情况,以及肿瘤在重T₂-SPACE序列中的信号特点。在常规MRI和重T₂-SPACE图像上分析肿瘤与腮腺导管、面神经的位置关系,判断腮腺肿瘤良恶性;以病理检查结果为金标准,对比两种方法诊断肿瘤良恶性的准确率。结果 重T₂-SPACE序列图像显示:51例腮腺肿瘤患者中共55个病灶,其中病灶位于腮腺浅叶25个,深叶16个,跨叶14个;34个病灶形态尚规则、边界清晰,21个病灶形状不规则、边界模糊;31个病灶内信号混杂,可见大小不等囊变坏死区。55侧患病腮腺在常规MR T₁WI、T₂W1和重T₂-SPACE序列上显示面神经分别为39、41、53侧,显示腮腺主导管分别为32、45、54侧;与常规MRI T₁WI、T₂W1比较,重T₂-SPACE序列显示面神经、腮腺主导管数量更多,信号更清晰。55个病灶中,常规MRI序列诊断良性病灶34个、恶性病灶21个,重T₂-SPACE序列诊断良性病灶35个、恶性病灶20个。以病理检查结果(良性病灶36个、恶性病灶19个)为金标准,常规MRI诊断肿瘤良性和恶性的准确率分别为75.0%(27/36)、12/19,总体准确率为70.9%(39/55);重T₂-SPACE序列诊断肿瘤良性和恶性的准确率为88.9%(32/36)、16/19,总体准确率为87.3%(48/55)。采用重T₂-SPACE序列诊断腮腺肿瘤良恶性的总体准确率高于常规MRI序列,差异有统计学意义(χ²=7.111, P＜0.05)。结论 重T₂-SPACE序列可以清晰显示腮腺肿瘤的位置、边缘及内部信号情况,可清晰显示腮腺肿瘤与面神经、腮腺导管的位置关系,对肿瘤良恶性判断、手术方案制定、术中面神经的保护及患者预后判断等具有一定的价值,值得在腮腺MR检查中推广应用。     

Further studies on renal nerve stimulation induced release of noradrenaline and dopamine from the canine kidney in situ

The renal venous outflow of dopamine and noradrenaline were studied in the canine kidney in situ in connection with renal nerve stimulation (RNS). RNS (0.5-4 Hz) caused frequency-dependent increases in the outflow of both catecholamines, which could be detected already at 0.5 Hz. The ratio dopamine/noradrenaline in renal venous plasma (approximately 0.15) was not influenced by varying the RNS parameters but was significantly enhanced (to about 0.25) by pretreatment with guanethidine according to a procedure previously used to demonstrate renal dopaminergic vasodilatation. The unstimulated kidney removed conjugated dopamine (which represents 98–99% of the total dopamine in plasma). During RNS the conjugated dopamine outflow to renal venous blood increased, but measurements of conjugated dopamine were less reliable than measurements of free dopamine to assess dopamine release from the kidney. When studying the renal nerve contributions to the renal venous outflow of dopamine and noradrenaline more accurate estimates may be obtained by correcting for the removal of catecholamines delivered to the kidney in arterial plasma. Such corrections were performed with endogenous adrenaline or radiolabelled noradrenaline. The two methods of correction yielded similar results and showed that RNS reduced catecholamine extraction in the kidney. The high ratio of dopamine/noradrenaline in kidney tissue (with a preferential distribution of dopamine to the cortex) and the dopamine outflow to renal venous plasma during RNS support the existence of specific dopaminergic nerves in the dog kidney.     

A study of diagnostic yield, technical ease and patient discomfort of low rate repetitive nerve stimulation test in patients with myasthenia gravis

AIM: The diagnostic yield of repetitive nerve stimulation (RNS) study in different muscles has been evaluated in myasthenia gravis (MG) but there is paucity of comprehensive study on technical ease and patient comfort. In this study we evaluate diagnostic yield of RNS test, technical ease and patient discomfort in 8 different muscles in patients with MG. METHODS: Consecutive patients with MG diagnosed on the basis of clinical evaluation, neostigmine test and/or acetylcholine receptor antibody (AchRAb) assay were subjected to 3 Hz RNS study in abductor digiti minimi (ADM), flexor carpi ulnaris (FCU), anconeus, deltoid, trapezius, serratus anterior (SA), nasalis and tibialis anterior (TA) at rest and 3 min after 30 s exercise. Decrement exceeding 10% was considered abnormal. Patient's discomfort was assessed on a 0-5 scale and technical difficulty by the number of repetitions needed to complete the test or abandonment of test. RESULTS: Thirty-three patients with MG whose age ranged between 16-81 y were evaluated. At the time of RNS study the predominant weakness was ocular in 3, oculobulbar in 13 and limb in 17 patients. The highest diagnostic yield of RNS test was with deltoid and nasalis (78.8% each), followed by trapezius (65.5%). The highest mean patient discomfort score was with deltoid (2.4), followed by nasalis (1.3). The technical difficulty was maximal in deltoid needing 36.4% repetitions followed by SA (33.3%). In oculobulbar group the best yield was in nasalis (92.3%) followed by deltoid (84.6%), and in limb variety deltoid (82.4%) followed by SA (80%) and trapezius (75%). Combining the diagnostic yield, patient comfort and technical ease; the choice of muscle for RNS should be ADM followed by trapezius for patient with predominant limb weakness, nasalis and trapezius in oculobulbar and nasalis in ocular.     

超声辐照微泡对肝细胞生长因子转染大鼠损伤面神经的促进作用

目的 观察超声微泡介导肝细胞生长因子(HGF)基因促进大鼠受损面神经修复的可行性及有效性.方法 将40只SD大鼠随机分成4组,A组:单纯手术组(PBS);B组:HGF+微泡组;C组:HGF+超声组;D组:HGF+超声+微泡组,每组10只.建立大鼠面神经损伤模型,以HGF作为治疗基因.基因转染后28 d,观察各组大鼠的一般情况,检测面神经传导速度、潜伏期及神经电位波幅的变化.处死各组大鼠,采用Westem blot和RT-PCR检测损伤面神经HGF蛋白和mRNA的表达.结果 经行为学检测,D组大鼠在触须摆动及鼻尖位置均明显优于其余3组.D组面神经传导速度、神经电位波幅明显高于其余3组,潜伏期明显低于其余3组(p＜0.05).D组中HGF蛋白和mRNA的表达量明显高于其他3组(P＜0.05).结论 微泡在一定频率和强度的超声作用下能够安全、有效的将目的基因转染进入损伤后的面神经,有利于受损面神经的修复.