食管心房调搏术终止阵发性室上性心动过速的疗效及安全性分析

目的：总结分析我院238例阵发性室上性心动过速行食管心房调搏术治疗的疗效及安全性。方法：使用心脏多功能刺激仪,采用亚速刺激法（低于室上性心动过速心率10～30次/min）→超速抑制法（高于室上性心动过速心率30～50次/min）→猝发脉冲法（快于室上性心动过速心率40%）,按次序进行转复阵发性室上性心动过速。同时观察转复瞬间心电图表现,同步记录心电图至少至室上性心动过速终止后10 s,转为房颤者继续观察直至恢复窦性节律。结果：使用亚速刺激法238例,成功转复32例,成功率为13.4%;使用超速抑制法206例,成功转复173例,成功率为83.9%;使用猝发脉冲法28例,成功转复21例,成功率为75.0%;总有效率为95.0%（226/238）。室上性心动过速终止瞬间心电图表现为：正常185例（77.7%）、P-R间期延长5例（2.1%）、房颤8例（3.4%）、交界性逸搏2例（0.8%）、长间歇〉1 500 ms 5例（2.1%）、单发室性期前收缩5例（2.1%）、成对室性期前收缩6例（2.5%）、短阵室性心动过速5例（2.1%）,除1例长间歇为3.2 s者予以72次/min频率的心房起搏外,余病例未予特殊处理。结论：食管心房调搏术终止阵发性室上性心动过速安全高效,可作为治疗折返性心动过速的首选方法。     

Idiopathic carpal tunnel syndrome (ICTS): Correlation between nerve conduction studies and dynamic wrist ultrasonography

Purpose

To evaluate accuracy of ultrasound in assessment of the dynamic wrist movements upon the median nerve for cases of idiopathic carpal tunnel syndrome.

Role of diffusion tensor imaging in carpal tunnel syndrome: A case control comparative study to electrophysiological tests and clinical assessment

Purpose

To study the efficacy of diffusion tensor imaging (DTI) in the diagnosis of carpal tunnel syndrome (CTS).

Involvement of the cAMP-dependent pathway in the reduction of epileptiform bursting caused by somatostatin in the mouse hippocampus

The cyclic AMP pathway is major signal transduction system involved in hippocampal neurotransmission. Recently, the peptide somatostatin-14 (SRIF) has emerged as a key signal that, by activating its receptors, inhibits epileptiform bursting in the mouse hippocampus. Little is known on transduction mechanisms, which may mediate SRIF function in native cell/tissues. Using a well-established model of epileptiform activity induced by Mg²⁺-free medium with 4-aminopyridine [0 Mg²⁺/4-aminopyridine (4-AP)] in mouse hippocampal slices, we demonstrated that protein kinase A (PKA)-related signaling is upregulated by hippocampal bursting and that treatment with SRIF normalizes this upregulation. We also demonstrated that the SRIF-induced inhibition of PKA impairs phosphorylation of the NMDA receptor subunit NR1. Extracellular recordings of the 0 Mg²⁺/4-AP-induced hippocampal discharge from the CA3 region demonstrated that treating slices with compounds, which interfere with PKA activity, prevent SRIF inhibition of epileptiform bursting. Our results suggest that SRIF modulation of hippocampal activity may involve PKA-related signaling.     

房室旁道间歇性逆传阻滞的探讨ioven

为探讨房室旁道间歇性逆传阻滞的发生机制及临床意义 ,对房室旁道患者射频导管消融术中作腔内电生理检查 ,观察房室顺传和室房逆传功能及途径。结果显示261例中有7例 (4例为隐匿性预激综合征 )为旁道逆向 (或双向 )传导阻滞 (2.7% )。尽管旁道间歇性逆传阻滞是一种少见现象 ,但由于旁道传导阻滞 ,无法对旁道进行定位及射频导管消融 ,因此了解旁道有无间歇性逆传阻滞 ,对射频导管消融治疗有临床意义     

跗管综合征的神经电生理诊断价值

目的探讨神经电生理检测对于跗管综合征的诊断价值。方法回顾性分析2019年1月至2021年11月于复旦大学附属华山医院就诊的32例(35侧)跗管综合征病人的神经电生理检测资料:(1)足内肌(小趾展肌或展肌)的复合肌肉动作电位(compound muscle action potential,CMAP);(2)足底内侧皮神经的感觉神经动作电位(sensory nerve action potential,SNAP);(3)足内肌的肌电图(electromyography,EMG)检测结果。结果足内肌CMAP的潜伏期为(6.4±2.0)ms,较健侧延长47.6%,波幅为(7.5±5.2)mV,较健侧降低59.7%;足底内侧皮神经SNAP的潜伏期为(2.4±0.6)ms,较健侧延长30.5%,波幅为(3.1±3.1)μV,较健侧降低78.4%;EMG检测结果:29侧足内肌出现自发电活动,34侧出现不同程度的主动募集反应减弱。结论 CMAP、SNAP、EMG检测对诊断跗管综合征均有重要价值,其中SNAP的波幅变化最为显著。     

Acute peripheral facial palsy: Is there a trigeminal nerve involvement?

The aim of this study was to investigate trigeminal nerve involvement in patients with peripheral facial palsy. In total, 25 patients with facial nerve palsy and 19 controls were tested by electrophysiological methods regarding their facial and trigeminal nerve functions within 1 month after disease onset. The presence of an abnormal blink reflex was determined in patients with peripheral facial palsy by comparing paralytic and non-paralytic sides (12.3 ± 1.1 and 10.8 ± 1.3, respectively; p = 0.001). However, the average masseter inhibitory reflex difference between the paretic and non-paralytic sides of patients compared with the corresponding side-to-side comparison for controls was not statistically significant. The masseter inhibitory reflex response was abnormal in some cases. These findings suggest that the masseter inhibitory reflex, a trigemino–trigeminal reflex, was normal in most of our patients with peripheral facial palsy, but may be abnormal in individual cases. Our study showed that subclinical disorders affecting the trigeminal pathways occur in individual patients with idiopathic facial palsy, while the majority of patients have no trigeminal nerve involvement.     

老年Miller-Fisher综合征患者的临床和神经电生理特点分析

目的研究老年Miller-Fisher综合征(MFS)患者的临床和电生理特征,并分析其预后。方法对9例老年MFS患者的临床表现、辅助检查、治疗和预后进行回顾性总结分析。结果本组男女比例4:5,患病年龄(68.3±4.1)岁,病程(19.2±9.9)d,发病主要在春冬季节,有呼吸道感染前驱史者3例,首发症状主要为头晕、头痛、眼睑下垂、复视、行走不稳和肢体麻木无力,起病至达峰平均(2.7±2.8)d;患者均有眼肌麻痹、共济失调和腱反射减弱或消失,眼胀痛5例,眼内肌受累2例,面神经受累4例,舌咽、迷走神经受累3例,四肢肌力减退3例,远端浅感觉减退或消失6例,自主神经受累3例;血清抗GQ1b抗体阳性5例,脑脊液示蛋白细胞分离6例,四肢肌电图异常7例,主要表现为感觉神经传导受累5例;患者应用激素和(或)免疫球蛋白治疗,头痛、眼胀痛、肢体麻木症状最早改善,眼外肌麻痹、共济失调分别在(2.5±1.5)d、(6.3±3.8)d时开始改善,腱反射异常在2~3周出院时无明显恢复;患者住院(15.0±4.6)d,出院时均好转。结论老年MFS临床表现多样,肌电图主要表现为感觉神经传导受累,血清抗GQ1b抗体有助于诊断,激素和(或)免疫球蛋白治疗后好转。     

颈椎前路植骨融合内固定术治疗平山病疗效的电生理评估

【摘要】 目的：通过电生理技术对接受颈椎前路植骨融合内固定手术治疗的平山病患者手术前后神经功能进行评估,探究手术干预对于神经功能恢复的作用。方法：回顾性分析2016年1月~2017年7月于我院骨科接受颈椎前路植骨融合内固定手术的平山病患者43例,其中男性41例,女性2例;手术时年龄14~26岁,平均18.2±2.8岁,病程6~84个月,平均22.3±20.1个月;随访时间3~18个月,平均7.2±4.4个月。所有患者均在术前及末次随访时接受上肢神经传导检查、针肌电图检查和上肢功能障碍评定（disability of arm shoulder hand,DASH）量表评估。通过比较复合肌肉动作电位（compound muscle action potential,CMAP）波幅、肌肉自发电位、运动单位电位形态及肌肉募集情况评估患者术后神经功能改变,并通过DASH量表评分变化评估患者术后上肢功能变化。分别比较术前症状严重侧和轻侧及手术前后电生理检查结果,通过配对样本t检验比较CMAP波幅,Pearson卡方检验比较肌肉自发电位、运动单位电位形态及肌肉募集情况;通过配对样本t检验比较手术前后DASH量表评分变化。结果：患者手术前神经电生理检查结果显示,症状严重侧正中神经及尺神经波幅较轻侧明显降低（P＜0.05）,超过半数患者针肌电图检查可见双侧神经源性损害。术前及术后随访结果对比显示,术前症状严重侧正中神经CMAP波幅平均为9.79±4.63mV,术后平均为11.04±4.43mV,差异有统计学意义（P＜0.05）;术前症状严重侧尺神经CMAP波幅平均为4.04±3.25mV,术后平均为6.19±4.30mV,差异有统计学意义（P<0.001）。轻侧正中神经及尺神经CMAP波幅恢复情况无统计学意义（P＞0.05）;针肌电图检查结果显示,患者严重侧上肢被检肌肉自发电位出现比例、MUAP形态宽大比例下降无统计学意义（P>0.05）;部分被检肌肉募集情况有较为显著改善,其中术前42例患者症状严重侧桡侧腕屈肌存在募集减弱（42/43,97.7%）,末次随访时32例患者同一肌肉存在募集减弱（32/38,84.2%）,差异有统计学意义（P＜0.05）。患者术前DASH量表评分为7.04±7.63分,末次随访时6.89±7.47分,差异无统计学意义（P>0.05）。结论：平山病患者接受颈椎前路植骨融合内固定手术后,上肢CMAP波幅提高,肌肉募集情况改善,该手术对控制病情进展、改善神经功能有积极作用。     

三磷酸腺苷治疗阵发性室上性心动过速的疗效和电生理作用

目的　评价三磷酸腺苷快速静脉注射治疗室上性心动过速的疗效、安全性和作用机制。方法　 45例患者应用食管电生理检查诱发持续性室上性心动过速 ,观察 2 0 mg三磷酸腺苷快速静脉注射转复室上性心动过速时的心电图改变 ,并比较了阿托品对之的作用。结果　三磷酸腺苷转复成功率为 95 .6% (4 3 /45 ) ,起效时间为 1 2～ 3 9(2 2± 9)秒 ;3 9/43例终止部位为房室结前向传导 ;瞬间心律失常发生率达 5 8% (2 5 /43 ) ,其中 2例患者发生严重心室静止分别达 9.3和 1 0秒 ,87%患者出现明显的头晕、胸闷、面色潮红、胸痛等副反应 ;曾应用阿托品诱发者似有较高的转复有效率 ,窦性 P波恢复时间明显缩短 (670± 2 3 0 ms对 980± 3 70 ms,p<0 .0 5 ) ,心脏外副反应的发生率减少 ,程度减轻 ,且未见高度房室传导阻滞发生。结论　三磷酸腺苷快速静脉注射治疗室上性心动过速具有高效、快速等特点 ,但副反应发生率较高 ,其主要作用机制可能为其对房室结的直接抑制作用