不同类型震颤的临床特点、发生机制及影响因素

目的:总结并分析各类震颤的特点及其机制和影响因素,为临床上各类震颤的鉴别及防治提供依据。资料来源:应用计算机检索Medline1998-01/2005-05关于震颤的文章。检索词“tremor”并限定文章的语种类为English。同时利用计算机检索中国期刊全文数据库1994-01/2005-05的相关文章,限定文章语言种类为中文,检索词“震颤”。资料选择:对资料进行初审,纳入标准:①关于震颤的分类、病因、影响因素。②对具体事件的回顾调查研究。排除标准:排除重复性研究。资料提炼:共收集到符合上述要求的文献48篇,排除31篇重复性研究。17篇符合纳入标准:其中9篇关于震颤的调查研究,8篇关于震颤的具体案例。资料综合:震颤的分型主要有依据震颤表现形式及根据基础疾病的病因学分类。其中机械性震颤、中枢神经系统的反射、中枢性振荡器是震颤的发生机制。依据震颤表现形式分为静止性震颤、运动性震颤、特定性震颤、姿势性震颤、无定型震颤。依据震颤的不同病因又分为增强的生理性震颤、特发性震颤综合征穴经典的特发性震颤、直立性震颤、任务和姿位特异性震颤、不能分类的震颤雪、肌张力障碍性震颤、帕金森病震颤、小脑性震颤、红核震颤、周围神经病性震颤、药物及有毒物质诱发的震颤和心因性震颤,临床上应根据不同的病因采取不同的治疗措施。结论:震颤虽表现形式类似,但发生原因各不相同,临床上应根据不同的病因采取不同的治疗措施。

Clinical characters, pathogenesis and influencing factors of different tremors

OBJECTIVE: To summarize and analyze the characters, pathogenesis and influencing factors of various tremors, so as to provide evidence for the identification, prevention and treatment of various tremors in clinic.DATA SOURCES: A computer-based online search of Medline database was undertaken to identify articles about tremor published in English between January 1998 and May 2005 with the keyword of "tremor". Meanwhile, Chinese relevant articles published between January 1998 and May 2005 were searched with computer in Chinese full-text journal net by using the keyword of "tremor" in Chinese. STUDY SELECTION: The data were primarily checked. Inclusive criteria: ① articles about the classification, etiological factors and influencing factors of tremor; ② retrospective investigation on specific events. Exclusive criteria: repetitive studies.DATA EXTRACTION: Totally 48 articles were collected, and 31 repetitive studies were excluded. Of the other 17 ones accorded with the inclusive criteria, 9 were the investigations about tremor, and 8 were the specific cases of tremor.DATA SYNTHESIS: Tremor is classified mainly according to its manifestations and the etiological factors of basic disease. Mechanical tremor,reflexion of central nervous system and central oscillator are the pathogenesis of tremor. According to the manifestations, tremor canbe classified into static tremor, kinetic tremor, essential tremor, postural tremor, unfixed tremor. According to the different etiological factors, tremor can be classified into enhanced physiological tremor, essential tremor syndrome (classical essential tremor, orthostatic tremor, task-specific tremor, undetermined tremor), dystonic tremor, cerebellar tremor, Holmes tremor, peripheral neuropathic tremor, drug-induced and toxic tremor and psychogenic tremor,and different treatments should be adopted according to different etiological factors in clinic.CONCLUSION: Tremor has similar manifestations, but the pathogenesis are different, so different treatments should be adopted according to different etiological factors in clinic.