Disinhibition of somatosensory evoked potential recovery in alcoholics

The pathogenesis of cognitive impairment in alcoholics remains unclear. Previous studies suggested that diffuse white matter atrophy is associated with cognitive impairment in alcoholics. To elucidate this issue, the present study evaluated alcoholics with cognitive impairment using the somatosensory evoked potential (SEP) recovery method, which is suitable for detecting subtle dysfunction at the cortical level. Subjects comprised 12 alcoholics with mild cognitive impairment [Mild group: Mini Mental State Examination Score (MMSE), ≥24; mean, 27.9 ± 1.6], 12 alcoholics with moderate to severe cognitive impairment (Moderate group: MMSE score, < 24; mean, 21.0 ± 2.5) and 12 normal subjects (Control group). SEP was recorded from the hand sensory area contralateral to the median nerve stimulated at the wrist. Single-pulse or paired-pulse stimuli at various interstimulus intervals (10–300 ms) were administered. Recovery functions of N9 (a peripheral nerve component), N20, N20-P25 and P25-N33 (cortical components) were studied. N20 recovery curves of both alcoholic groups were less suppressive than those of Controls, and P25-N33 recovery curves of the Moderate group were more excitatory than those of the Mild or Control groups. A disinhibited recovery pattern of N20 indicates subcortical dysfunction, and a disinhibited pattern of P25-N33 would be induced by cortical dysfunction. Therefore, subcortical dysfunction indicated by an abnormal N20 recovery pattern may contribute to the early cognitive impairment of alcoholics, whilst the cortical dysfunction indicated by an abnormal P25-N33 recovery pattern may contribute to the later cognitive impairment of alcoholics.     

单发室性早搏中RT间期规律的分析

目的探讨室性早搏前后RT间期变化的规律。方法选取单发、有完全代偿间期的室性早搏心电图,测量室早及其前后相邻波群(简称室早前、室早、室早后)的RT间期,进行对比。对室早前心室舒张时间与室早RT间期变化的关系进行分析。结果RT间期由短到长的顺序为:室早<室早前<室早后。室早前心室舒张时间与室早RT间期无线性相关关系。结论室早时RT间期最短,室早后RT间期最长,这一变化规律与心室舒张时间无关。     

恩必普软胶囊改善慢性脑供血不足患者认知功能的临床分析

目的:探讨dl-3-正丁基苯酞软胶囊(恩必普软胶囊)治疗慢性脑供血不足的临床疗效及对慢性脑供血不足病人认知功能改善的影响。方法:将60例慢性脑供血不足病人随机分为治疗组和对照组,每组30例,治疗组口服dl-3-正丁基苯酞软胶囊,每次200毫克,每日3次;对照组口服复方丹参片,每次4片,每日3次,疗程为8周,治疗前后进行疗效评价和P300数据采样,同时给予同步MMSE、HDS量表评分。结果:治疗组总有效率为70%,对照组总有效率为53.3%,2组治疗后比较差异有显著意义(P<0.05);治疗组治疗前、后MMSE和HDS量表得分情况比较,均有明显改善(P<0.01),与对照组治疗后比较差异有显著意义(P<0.05);治疗组治疗前、后P300波潜伏期及P300波幅差异均有显著意义(P<0.05),与对照组治疗后比较均有显著差异(P<0.05)。结论:dl-3-正丁基苯酞软胶囊对慢性脑供血不足病人安全有效。     

Heterotopic ischemic pain attenuates somatosensory evoked potentials induced by electrical tooth stimulation: diffuse noxious inhibitory controls in the trigeminal nerve territory.

The purpose of this study was to determine whether the late component of somatosensory evoked potentials (SEP) induced by electrical tooth stimulation and pain intensity are inhibited by heterotopic ischemic stimulation. The tourniquet pressure with 50 mmHg greater than the individual's systolic pressure was applied to the left upper arm for 10 min as ischemic conditioning stimulation. The late component of SEP and visual analogue scale (VAS) were recorded at 4 times and both were significantly decreased when ischemic conditioning stimulation was applied. The maximum reductions in SEP amplitude and the VAS value were 26.1% and 21.2%, respectively, during ischemic conditioning stimulation. After-effect was observed 5 min after removal of the conditioning stimulation. The present study revealed that heterotopic ischemic stimulation attenuated the late component of SEP induced by electrical tooth stimulation, triggering diffuse noxious inhibitory controls (DNIC) and after-effects in the trigeminal nerve territory. It was also suggested that the DNIC effect differs, depending on the intensity, kind, and quality of the test and conditioning stimuli.     

偏头痛患者发作期间听觉诱发电位和经颅多谱勒的变化

目的:研究偏头痛患者经颅彩色多谱勒(TCD)和脑干听觉诱发电位(BAEP)变化并探讨其临床意义. 方法:偏头痛患者350(男128,女222)例,年龄17~49岁,病程5 mo~12 a. 典型偏头痛185例(单侧头痛105例,双侧头痛80例),普遍偏头痛165例(单侧头痛95例,双侧头痛70例). 对照选择健康体检者135(男55,女80)例,年龄20~48岁. 全部患者在偏头痛发作期间同时进行TCD和TBAEP检查. 结果:在350例偏头痛患者中脑血流增快224例(64.0%),血流减慢110例(31.4%),血流正常16例(4.6%),总异常率95.43%. 典型偏头痛患者MCA(cm/s,大脑中动脉)和PCA(cm/s,大脑后动脉)均高于对照[(70± 7) vs (62±8),P<0.05; (48±9) vs (37±8),P<0.05]和普通偏头痛(61±6, P<0.05; 40±9, P<0.05). 偏头痛患者发作期脑干听觉诱发电位(BAEP)异常率为52.9%(185/350),表现为Ⅰ, Ⅲ, Ⅴ波潜伏期及Ⅲ~Ⅴ峰间期延长. 偏头痛发作间期BAEP正常. 偏头痛病程越长BAEP异常率越高,听神经损害的可能性越大. 结论:偏头痛发作期间有部分脑血流改变,同时有BAEP改变,病程越长BAEP异常率越高,听神经损害的可能性越大. 提示TCD和BAEP对偏头痛有一定诊断价值.     

介导感觉生理功能的瞬时受体电位通道蛋白(TRP)家族研究进展

瞬时受体电位通道蛋白(TRP)家族由一类特殊的阳离子通道蛋白组成,在神经细胞及其他非兴奋细胞中有重要作用,其中在介导多种感觉生理功能方面的作用尤其显著.TRP结构与功能的深入研究为阐明感觉生理功能的分子机制提供了重要线索.本文综述TRP家族在温度感受、机械刺激感受、光感受和化学信号感受等方面的研究进展.     

副神经移位膈神经后膈肌运动诱发电位与病理学对照研究

[目的]探讨副神经移位膈神经重建高位颈髓损伤大鼠呼吸功能后膈肌的病理学变化及膈肌运动诱发电位(motion evoked potential,MEP)的特点。[方法]健康雄性SD大鼠60只。随机分为1～6个月6个时间组。取下颈部正中切口,将双侧副神经在锁骨下水平发出内、外侧支之前切断,移位缝接膈神经干起始部。术后第1～6个月各组样本取颈后正中切口,切除C3全椎板充分显露颈髓并于C3、4水平锐性横断。证实胫前肌MEP完全消失后,于两侧腋前线肋下缘作切口,显露该处膈肌腹腔侧。直视下将同心针电极于腋前线第9肋骨下缘垂直胸壁插入膈肌肋部,监测其MEP的变化。然后完整取出膈肌,于电子天平称重。并于右侧腋前线顺膈肌肌纤维方向切取2 mm宽肌条行HE染色。分析膈肌肌纤维截面积的变化。[结果]神经移位后随着时间延长,大鼠膈肌MEP潜伏期逐渐缩短,波幅逐渐增大。6个月组MEP波幅为(6.35±0.51)mV,潜伏期为(3.41±0.36)m s。同时,膈肌逐渐饱满,肌重逐渐恢复,6个月为正常对照组的(97.23±4.07)%。肌纤维截面积也逐渐增大,6个月组达(1 741±439)μm2为正常对照组(1 809±461)μm2的(98.28±3.65)%。6个月组的各数据与对照组比无显著差异(P>0.05)。[结论]从电生理及病理学来看副神经可作为运动神经移位膈神经重建高位颈髓损伤后呼吸功能。     

舒芬太尼用于全凭静脉麻醉40例研究

目的：探讨舒芬太尼全凭静脉复合麻醉时对听觉诱发电位指数、血流动力学和术后复苏的影响.方法：40例美国标准协会（ASA）Ⅰ～Ⅱ级病人择期行胆囊切除手术,随机分为Ⅰ组（舒芬太尼组）和Ⅱ组（芬太尼组）,记录两组病人麻醉期间各时间点的听觉诱发电位指数（AEPI）值、收缩压、舒张压、心率和SpO2.结果：Ⅱ组插管后1 min、2 min的收缩压较Ⅰ组升高,而插管后1 min的心率较Ⅰ组降低（P＜0.05）;Ⅰ组插管后1 min、2 min和3 min时的AEPI值低于Ⅱ组（P＜0.05）;Ⅰ组拔管后至定向力恢复的时间较Ⅱ组长（P＜0.05）;Ⅰ组丙泊酚的用量较Ⅱ组少（P＜0.05）.结论：等效剂量的舒芬太尼较芬太尼的全凭静脉复合麻醉可以使病人达到更为合适的麻醉深度,并能使血流动力学更加稳定,同时可减少丙泊酚用量.     

老年期抑郁症病人听觉事件相关电位P300的比较研究

目的 探讨老年期抑郁症病人的认知功能状况。方法 按CCMD-3中心境障碍抑郁发作诊断标准，收集33例60岁以上首次抑郁发作的病人(抑郁组)，32名健康老年人(对照组)。使用HAMD、HAMA和MMSE量表对所有入组者进行评定，并作P300测定。结果 抑郁组MMSE总分低于对照组。抑郁组N2和P3潜伏期比对照组延长；抑郁组的P300潜伏期N2和P3与HAMD的迟缓因子分呈正相关，与MMSE总分呈负相关。结论 老年期抑郁症病人存在认知功能障碍。     

颈内动脉大型和巨大型动脉瘤的手术策略

目的探讨颈内动脉巨大动脉瘤的特点和手术策略。方法回顾性分析48例颈内动脉大型和巨大型动脉瘤的手术经验。手术均采用翼点人路，床突旁动脉瘤病例预先暴露颈部颈内动脉以备临时阻断。从硬脑膜内磨除前床突、视神经管上壁以及外侧嵴，以显露动脉瘤的近侧角。术中采用逆向抽吸法使动脉瘤塌陷，如动脉瘤内含机化血栓，则在临时阻断后切开瘤体，用CUSA和取瘤镊去除瘤内血栓，再将动脉瘤夹闭并达到视神经减压的目的。术中监测脑电图和体感诱发电位，并采用术中超声多普勒检查动脉血流。结果46例动脉瘤直接夹闭，2例海绵窦段动脉瘤行动脉瘤孤立并分别做颞浅动脉-大脑中动脉和大隐静脉移植颈外动脉-大脑中动脉搭桥手术。43例术后行DSA检查，绝大多数动脉瘤夹闭满意。按GOS评分术后良好为41例（85．4％），差为5例，死亡2例。结论充分显露、合理应用临时阻断技术、有效的动脉瘤减压，以及术中应用电生理监测和超声多普勒检查等辅助措施，能够取得动脉瘤的满意夹闭。