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1、贵 阳 医 学 院硕 士 学 位 论 文脑 卒 中 偏 瘫 患 者 周 围 神 经 的 超 声 及 电 生 理 改 变姓 名 ： 蒲 云 涛申 请 学 位 级 别 ： 硕 士专 业 ： 神 经 病 学指 导 教 师 ： 吴 珊2011 贵阳医学院 届 硕 士 学 位 论 文脑 卒 中 偏 瘫 患 者 周 围 神 经 的 超 声 及 电 生 理 改 变 专 业 ： 神 经 病 学 研 究 生 ： 蒲 云 涛 导 师 ： 吴 珊摘 要 目的：观察脑卒中偏瘫患者正中神经、尺神经、腓总神经超声下的形态学变化以及电生理下功能学变化。方法：随机选取脑卒中偏瘫患者 例，采集患者的性别、年龄、病程以及肌力等基
2、本信息资料，运用超声技术分别检测双侧正中神经、尺神经、腓总神经的横截面积（，） 、边界以及受压表现，并同时运用电生理检测各神经的潜伏期、波幅以及传导速度。在超声结果与神经传导速度结果中分别做统计学分析，同时在超声结果与年龄、病程时间以及神经传导速度结果之间做相关性分析。结果：、正中神经在超声下的改变主要集中在 增粗，患侧组与健侧组比较无明显差异，双侧均较对照组明显增粗（）；感觉波幅患侧组较健侧组明显降低（） ，感觉和运动波幅、感觉传导速度双侧均较对照组明显降低（） 。、尺神经在超声下的改变主要集中在边界不清，患侧组较健侧组在肘管入口处明显增粗（ ），双侧均较对照组明显增粗（ ）；感觉波幅患侧组
3、较健侧组明显降低（） ，感觉和运动波幅、感觉传导速度双侧均较对照组明显降低（） 。、腓总神经在超声下的改变主要集中在边界不清，患侧组与健侧组比较无明显差异；感觉波幅、运动传导速度患侧组较健侧组明显降低（） ，感觉潜伏期双侧均较对照组明显延长（） ，感觉波幅、传导速度以及运动波幅双侧均较对照组明显降低（），运动传导速度患侧组较对照组明显降低（） 。、正中、尺神经超声异常率明显高于电生理（ ），腓总神经电生理异常率明显高于超声（）；各神经超声异常率患侧与健侧无明显差异，电生理患侧异常率明显高于健侧（）； 电生理的改变主要表现在感觉神经传导异常。、正中、尺以及腓总神经 与年龄呈正相关，与病程时间无显
4、著相关性，1 贵阳医学院 届 硕 士 学 位 论 文与神经传导潜伏期呈正相关，与神经传导波幅和速度呈负相关。结论：、脑卒中后偏瘫患者可发生周围神经损伤，其在超声下的变化在主要是 增粗，在电生理下的变化主要是感觉传导异常。、脑卒中后偏瘫患者周围神经可出现双侧损伤，超声以及电生理异常检出率各不相同。、脑卒中后偏瘫患者周围神经 与年龄呈正相关，与病程时间无显著相关性；与神经传导潜伏期呈正相关，与神经传导波幅和速度呈负相关。关 键词 ：脑卒中 超声 神经传导速度 正中神经 尺神经 腓总神经 2 贵阳医学院 届 硕 士 学 位 论 文The ultrasonographic and electrophy
5、siological changes of peripheralnerve in stroke patients with hemiplegiaPu yuntao Wushan Affiliated hospital of Guiyang medical college 550004AbstractObjective: To investigate the changes of ultrasonographic morphology andelectrophysiological function in stroke patients with hemiplegia.Methods: 100
6、cases of stroke patients were selected randomly .The patientsgender, age, duration and strength, and other basic information were collected. Thenerve cross-sectional area（ CSA） and detailed description at multiple sites along theentire length of median nerve(MN), ulnar nerve(UN) and common peronealn
7、erve(CPN) were obtained by ultrasonography. The latency, amplitude and nerveconduction velocity(NCV) were detected by electrophysiology. The relationship ofCSA with age, duration time and electrophysiological features were analyzedseparately.Results: 1 、 The CSAs increasing were observed at multi-si
8、te in MN byultrasonography. There were no significant differences between the paretic upperlimbs and the nonparetic upper limbs but the CSAs in bilateral side were significantlylarger than that of healthy people (P 0.05). The sensory amplitude of MN in pareticside was significantly lower than that o
9、f nonparetic side (P 0.05) and the sensory andmotor amplitude, sensory conduction velocity(SCV) of MN in both side were alsoreduced (P 0.05).2、 The fuzzy boundary was the main ultrasonographic feature in UN,but the CSAwas found larger at the entrance of cubital tunnel in the paretic side than that o
10、fnonparetic side (P 0.05). Compared with healthy people, the CSAs of bilateral sidewere significantly increasing in stroke patients (P 0.05). The sensory amplitude ofUN in paretic side was lower than that in nonparetic side (P 0.05) and the sensoryand motor amplitude, sensory SCV of UN in both side
11、were damaged (P 0.05).3、 The ultrasonographic changes of common peroneal nerve(CPN) also focusedon the fuzzy boundary. There were no significant differences between the paretic sideand the nonparetic side. The sensory amplitude and motor conduction velocity(MCV)of CPN in paretic lower limbs were sig
12、nificantly lower than that of nonparetic side (P0.05). The sensory latency of CPN was delayed and the sensory and motoramplitude, SCV of CPN were significantly reduced in bilateral lower limbs (P 0.05).23 贵阳医学院 届 硕 士 学 位 论 文The MCV in paretic lower limb was significantly lower than that of control (
13、P 0.05).4、 The percentage of abnormal ultrasonographic images in MN and UN weresignificantly higher than that of electrophysiology(P 0.05), but in the CPN the resultwas opposite (P 0.05). The ultrasonographic abnormal rates of peripheral nerve werethe same at both side . The electrophysiological abn
14、ormal rates of paretic side werehigher than that of nonparetic side group (P 0.05). The main electrophysiologicalchanges was the sensory conduction injury.5、 The CSAs of MN, UN and CPN were positively correlated with age and nerveconduction latency, but it was negatively correlated with nerve conduc
15、tion amplitudeand velocity. The CSA had no significant correlation with duration.Conclusions:1 、 Peripheral nerve injury can occur in stroke patients withhemiplegia. The ultrasonographic changes of peripheral nerve focus on the increasingof CSA, and the electrophysiological changes of peripheral nerve focus on theabnormal of sensory conduction.2、 Stroke
