脑卒中肩手综合征患者感觉障碍的定量分析

背景脑卒中偏瘫后肩手综合征(shoulder-hand syndrome,SHS)患者感觉减退已被证实,而感觉障碍的评估多用问卷式调查或仅为粗略临床检查来完成,难以精确评估.目的运用定量感觉检查技术(quantitative sensorytesting,QST)检查脑卒中后肩手综合征观察组和脑卒中对照组各15例患者的温度觉及振动觉,并进行定量分析,以了解小纤维神经功能状态及其与肩手综合征的关系.设计病例对照研究(case-control study).地点和对象研究地点为中南大学湘雅三医院,对象涉及2000-06/2001-04湘雅三医院门诊及住院脑卒中后瘫痪病例.方法用界限法分别检查观察组与对照组偏瘫侧上肢大鱼际掌侧温度觉阈值与拇指掌侧振动觉阈值.检查温度觉时,使用一个小的与检测区皮肤接触的热电极探头,探头温度以1℃/s速度递增(热觉、热痛觉)或递减(冷觉、冷痛觉),直至受检者产生感觉的那一刻由受检者本人按下按钮停止刺激.得到一个温度觉阈值,探头温度恢复到预置温度准备下一次刺激.重复4次得到平均温度觉阈值.在检测振动觉时,振动器的刺激强度以0.1～12 μm/s的速度递增,重复检测6次.主要观察指标感觉障碍发生率,温度觉、痛觉及振动觉的数据.结果SHS组中感觉障碍发生率为67%较对照组27%显著增高(P＜0.05).SHS组与对照组定量感觉比较,主要表现为冷觉阈值降低(分别为26.73±4.48,29.89±1 57,P＜0.05),热觉阈值增高(分别为36.83±1.90,35.40±0.89,P＜0.05).冷痛觉阈值、热痛觉阈值与振动觉阈值之间的差异无显著性意义.冷痛觉阈值与冷觉阈值的差值(P＜0.01)及热痛觉阈值与热觉阈值之间差值(P＜0.01)差异有显著性意义.结论脑卒中偏瘫后SHS患者感觉障碍发生率显著增高.主要形式为温度觉减退和痛觉过敏.C类和Aδ类神经纤维功能障碍可能在SHS发病中起重要作用.

Quantitative sensory study on post-stroke shoulder-hand syndrome

BACKGROUND: It is certain that patients with shoulder-hand syndrome (SHS) have a decline in sensation. However, questionnaire or clinical evaluation for sensory disorder is not accurate.OBJECTIVE: To explore the thermal and vibration sensations of post-stroke patientsby quantitative sensory testing(QST) in an attempt to assess the relationship between small nerve fibre function and SHS.DESIGN: A case-controlled study.SETTING AND SUBJECTS: Thirty cases of post-stroke paralysis were selected from outpatients and inpatients in the Third Xiangya Hospital of Central South University from 2000-06 to 2001-04.METHODS: Limit method was carried out to examine thermal, pain and vibration sensations of affected upper limbs of the matched control patients (control group, n = 15) and the patients with post-stroke shoulder-hand syndrome (SHS group, n = 15 ). Incidences of shoulder-hand syndrome in two groups were also compared.MAIN OUTCOME MEASURES: The incidence of sensory disorder, thermal, pain and vibration sensation.RESULTS: Incidence of sensations dysfunction in SHS group was 67 %,significantly higher than that in control group(27% , P ＜ 0. 05) . Lowered cold-threshold(26.73 +4.48 vs 29.89 + 1.57, P ＜ 0.05) and elevated warm-threshold(26.73 +4.48 vs 29.89 + 1.57, P ＜ 0.05) were found in both SHS group and control group without significant difference between them. Difference among cold-evoked pain, heat-evoked pain and vibration thresholds was found significantly( P ＜ 0.01 ) . Differences between cold evoked pain threshold and cold threshold, as well as heat-evoked pain threshold and warm threshold were significant( P ＜ 0.01 ).CONCLUSION: Incidence of disordered sensation function in post-stroke paralyzed patients with SHS increases significantly, which mostly presents by reduced thermal sensation and hyperalgesia. C and Aδ nerve fibre dysfunction may play an important role in the pathogenesis.