躯体感觉诱发电位早期预测脑卒中预后的价值

目的探讨躯体感觉诱发电位（SSEP）在脑卒中急性期预测患者预后的价值。 方法选择发病1周之内脑卒中患者150例,根据SSEP检测结果分为 SSEP正常组、SSEP异常组和SSEP缺失组,分别于入院时和病后第1,3,6及12个月时采用美国国立卫生研究院脑卒中量表（NIHSS）、简化Fugl-Meyer运动功能评分法（FMA）、改良Barthel指数（MBI）及改良Rankin量表（MRS）进行评分,同时进行SSEP检测。 结果脑卒中后不同时期的NIHSS和FMA评分,无论是组间比较还是组内不同时间点变化的比较,差异均具有统计学意义。脑卒中早期患者正中神经SSEP的N20潜伏期及胫神经SSEP的P40潜伏期与脑卒中12个月时MRS评分呈正相关,与MBI评分呈负相关。以脑卒中后12个月时的日常生活活动能力恢复程度为结局,单独的SSEP检测对预后的预测率为40.8%,SSEP结合FMA评分对预后的预测率为44.2%,SSEP结合FMA和MRS评分对预后的预测率为46.1%。 结论SSEP具有早期独立预测脑卒中预后的价值,SSEP结合FMA和MRS评分对预后的预测价值更大。     

脑出血患者的脑干听觉诱发电位与预后的关系

目的:探讨脑干听觉诱发电位(BAEP)在脑出血患者中的应用价值。方法:对50例脑出血患者在发病3d内行脑干听觉诱发电位检测,并行健、患侧Ⅰ、Ⅲ、Ⅴ波潜伏期及波间期比较,并观察其预后。结果:脑出血患者健患侧Ⅴ波潜伏期及Ⅲ～Ⅴ、Ⅰ～Ⅴ波间期有明显差异。患者患侧V波潜伏期及Ⅲ～Ⅴ波间期与美国国立卫生研究院卒中量表(NIHSS)评分有相关性。结论:BAEP在脑干出血的定位及定侧上有一定临床参考意义,可用于脑出血患者病情严重程度及预后的判断。     

体感诱发电位和改良脑出血量表在脑出血患者肢体运动功能预测中的应用

Objective To evaluate the extremity function of patients with intracerebral hemorrhage (ICH)using short-latency somatosensory evoked potentials (SEPs) and a modified intracerebral hemorrhage (MICH) scale.Methods On admission, SEP was applied in the examination of 61 patients with ICH. P40 latency and the amplitude of posterior tibial nerve potentials in both the healthy and affected extremities were measured. Abnormalities were classified based on the margin of lower extremity SEP latency and the main waveform changes. MICH was measured simultaneously to prepare a prognosis. The modified Rankin scale (MRS) score was assessed 3 months after the attack as well.Results Compared with the healthy side, there were significant differences in posterior tibial nerve P40 latency and amplitude on the affected side among patients with ICH. P40 latency and MRS scores on the affected side 3 months after the attack were positively correlated. On the unaffected side, P40 amplitude and the MRS score 3 months after the attack were negatively correlated. The MICH score on admission and the MRS score 3 months after the attack were positively correlated. Based on MRS scores (MRS≥4 indicating a poor prognosis), the predictive sensitivities for a poor prognosis of SEP and the MICH scale in patients with ICH were 80.77% and 84.61% respectively, while the specificities were 62.68% and 88.57% respectively, and the accordance rates were 70.5% and 86.9% respectively. Conclusions SEP and the MICH scale are closely correlated with the prognosis for extremity function in patients with ICH.The combination of SEP with the MICH scale might be helpful in predicting the prognosis of the patients with ICH.     

体感诱发电位和改良脑出血量表在脑出血患者肢体运动功能预测中的应用

Objective To evaluate the extremity function of patients with intracerebral hemorrhage (ICH)using short-latency somatosensory evoked potentials (SEPs) and a modified intracerebral hemorrhage (MICH) scale.Methods On admission, SEP was applied in the examination of 61 patients with ICH. P40 latency and the amplitude of posterior tibial nerve potentials in both the healthy and affected extremities were measured. Abnormalities were classified based on the margin of lower extremity SEP latency and the main waveform changes. MICH was measured simultaneously to prepare a prognosis. The modified Rankin scale (MRS) score was assessed 3 months after the attack as well.Results Compared with the healthy side, there were significant differences in posterior tibial nerve P40 latency and amplitude on the affected side among patients with ICH. P40 latency and MRS scores on the affected side 3 months after the attack were positively correlated. On the unaffected side, P40 amplitude and the MRS score 3 months after the attack were negatively correlated. The MICH score on admission and the MRS score 3 months after the attack were positively correlated. Based on MRS scores (MRS≥4 indicating a poor prognosis), the predictive sensitivities for a poor prognosis of SEP and the MICH scale in patients with ICH were 80.77% and 84.61% respectively, while the specificities were 62.68% and 88.57% respectively, and the accordance rates were 70.5% and 86.9% respectively. Conclusions SEP and the MICH scale are closely correlated with the prognosis for extremity function in patients with ICH.The combination of SEP with the MICH scale might be helpful in predicting the prognosis of the patients with ICH.     

早期体感诱发电位检测对脑出血患者肢体运动障碍程度及预后判断的研究

目的 探讨早期检测脑出血患者短潜伏期体感诱发电位（short-latency somatosensory evoked p otential,SLSEP）在判断肢体瘫痪程度及预后中的意义。方法 对62例天幕上脑出血患者在发病10d内检测SLSEP,根据SLSEP异常程度不同将患者分成轻度、中度及重度异常3组。在发病初期及发病后3个月,按改良受丁堡－斯堪的那维亚脑卒中量表中肢体运动功能部分（partial revised Edinburgh-Scandinavia Stroke Scale,PRESSS）对每位患者计算积分,并根据积分的多少将患者分为轻度、中度及重度瘫痪。结果 在发病初期及3个月后,不同程度SLSEP异常患者组间的PRESSS积分差异有显著性意义（P＜0.05）,SLSEP异常程度越严重,PRESSS积分越坑,肢体瘫痪越严重;按二种方法分组的实际一致率分别为74.19％及66.13％。结论 对脑出血患者早期检测SLSEP有助于判断瘫痪肢体运动障碍的严重程度及预后。     

体感诱发电位和脑卒中患者上肢运动功能结局的关系

目的:评估正中神经体感诱发电位(SEP)与急性期脑卒中上肢运动功能的相关性及其对上肢运动康复潜能的预测作用。方法:27例脑卒中患者在急性期行正中神经SEP检测,评估简化Fugl-Meyer运动功能评分(FMA)上肢部分、改良Ashworth评分、美国国立卫生院神经功能缺损评分(NIHSS)、改良Barthel指数(MBI)。其中22例患者3个月后再次评估以上量表。对正中神经SEP N20的振幅、潜伏期与急性期及3个月后的各项量表做相关性分析。结果:患侧正中神经SEP的N20潜伏期较健侧延长,振幅较健侧减低(P0.05)。患侧正中神经SEP N20消失的急性期脑卒中患者,其患侧上肢FMA评分和MBI低于N20可引出者(P0.05)。22例患者3个月后患侧上肢FMA评分和MBI较急性期增高(P0.05)。急性期患侧正中神经SEP的N20潜伏期与3个月后患侧上肢FMA评分负相关(P0.05)。结论:急性期脑卒中患侧正中神经SEP N20消失者上肢运动功能和自理能力较差。正中神经SEP N20潜伏期可预测急性期脑卒中患侧上肢运动功能康复潜能。     

规范的三级康复治疗对脑出血后患者上肢痉挛程度及运动功能的影响

目的探讨规范的三级康复治疗对脑出血后上肢痉挛和上肢运动功能的影响。 方法将364例脑出血患者按随机数字表法分为对照组（181例）和康复组（183例）,康复组接受规范的三级康复治疗,包括早期床旁康复介入、恢复期在康复专科病房进行、后期定期康复家访指导;对照组未接受规范的三级康复治疗,仅予以康复指导,并定期随访。分别于入组时、入组后1、3和6个月时,对2组患者患侧上肢进行改良Ashworth量表（MAS）评定和简化Fugl-Meyer运动功能（上肢部分）评定,并进行统计学分析比较。 结果入组时,对照组和康复组患者肌肉痉挛的发生率分别为22.7%和23.5%;入组后6个月,对照组和康复组痉挛发生率分别为59.7%和43.2%,且对照组处于MAS 1+级和2级患者数量（50/181）明显高于康复组（25/183）。无论在哪个阶段,2组MAS 0级患者数量均占很大比例。入组后6个月,2组患者的MAS分布和评分比较,差异均有统计学意义（P<0.01）。2组患者的Fugl-Meyer评分均随时间的推移逐渐明显提高（P<0.01）;入组后1、3和6个月时,康复组Fugl-Meyer评分分别为（24.71±19.80）、（39.83±19.50）和（48.87±18.25）分,对照组分别为（17.13±16.46）、（24.87±18.36）和（30.68±19.41）分,康复组各时间点评分均高于同时间点对照组（P<0.01）。 结论规范的三级康复治疗有助于减轻脑出血后患者的上肢痉挛程度和改善上肢运动功能。     

术中皮质躯体感觉诱发电位监测对脊髓功能及预后判定的价值

目的探讨术中皮质躯体感觉诱发电位（CSEP）监测对客观评价脊髓功能及完整性并判断神经功能预后的价值。 方法对56例脊柱脊髓手术患者，实施手术前、中、后CSEP监测，观察并分析其潜伏期及波幅，波幅降低≥50%或潜伏期延长≥10%为明显改变，即报警标准。 结果真阴性71.43%（40/56），术中潜伏期及波幅均无异常变化，术后无新的神经功能障碍；假阴性1.79%（1/56），术中CSEP无明显变化，但术后患者出现新的神经功能障碍；真阳性26.79%（15/56），手术过程中CSEP出现短暂潜伏期延长<10%、波幅下降<50％，暂停操作或改变操作方向后波形恢复或改善。 结论在脊柱手术中，CSEP对脊髓的牵拉、缺血以及损伤很敏感，术中及时干预，可使CSEP恢复或改善；CSEP能较好地反映脊髓功能及完整性，对防止术中脊髓损伤、判定神经功能预后有重要价值。     

高压氧治疗高血压脑出血患者的疗效观察

目的观察高压氧治疗高血压脑出血患者的临床疗效。 方法采用随机数字表法将80例高血压脑出血患者分为治疗组及对照组。2组患者均早期给予脱水降颅压、止血、降压、扩张脑血管、营养脑神经、运动训练等常规干预，治疗组患者在此基础上辅以高压氧(HBO)治疗。于发病后24h内、发病后7d及HBO治疗1周、2周时分别采用神经功能缺损程度量表（NFDS）对2组患者神经功能进行评定。 结果在发病后24h内及发病后7d时，2组患者NFDS评分组间差异均无统计学意义（P&rt;0.05）；在HBO治疗1周及2周时，发现治疗组患者NFDS评分［分别为（12.08±4.07）分和（9.65±3.68）分］均较对照组［分别为（16.50±5.57）分和（14.15±4.95）分］显著下降，组间差异均具有统计学意义（P<0.05）。 结论HBO治疗能进一步促进高血压脑出血患者神经功能康复、改善患者预后，该疗法值得临床推广、应用。     

康复护理理论下的体感模拟训练在脑出血患者中的应用

目的：探讨康复护理理论下的体感模拟训练在脑出血患者中的应用效果。方法：选取2019年12月31日～2021年12月31日收治的90例脑出血患者为研究对象，依据干预方法不同分为对照组和实验组各45例，对照组采用常规康复训练，实验组在对照组基础上采用康复护理理论下的体感模拟训练；比较两组体感诱发电位(SEP)检测结果、神经功能[采用神经功能缺损量表(NIHSS)]、肢体运动情况(采用简式Fugl-Meyer量表)、生活活动能力[采用改良Barthel指数(MBI)]、生活质量[采用生活质量测定简表(WHOQOL-BREF)]。结果：干预后，两组N9、N20波幅和潜伏时间均优于干预前(P<0.05),且实验组优于对照组(P<0.05,P<0.01);干预后，实验组NIHSS评分低于对照组(P<0.05),Fugl-Meyer量表评分、MBI评分、QOL-BREF评分均高于对照组(P<0.05)。结论：将康复护理理论下的体感模拟训练应用于脑出血患者中，可增强患者肢体功能、中枢神经的运动传导功能，加快神经功能恢复，减轻功能障碍，提高生活质量。