【作者】 彭超；

【导师】 许光旭；

【作者基本信息】 南京医科大学 ， 康复医学与理疗学， 2010， 硕士

【摘要】 目的:研究旨在观察不同损伤程度与平面对脊髓损伤(SCI)患者交感神经皮肤反应(SSR)的影响,探索SCI后自主神经功能评估的客观方法及SSR对SCI损害程度评定的意义。对象和方法:对象自2009-03～2010-03住院患者中选出完全性SCI组:10例(男/女:7/3),年龄38.8±12(22~59)岁,平均身高1.63±0.06m(1.55~1.75m),损伤平面T6以上3例,T8~T11为7例,损伤程度分级(AIS)为A,平均病程6.(22.5~18)月。不完全性SCI组:10例(男/女:9/1),年龄36.3±13(15~59)岁,平均身高1.67±0.06m(1.55~1.78m),损伤平面T6以上5例,T6~L3为5例,损伤程度分级(AIS)为B-2例,C-5例,D-3例,平均病程11.1(2~48)月。对照组(H):正常青年大学生中随机选出对照组正常健康受试者20例(男/女,11/9;年龄25±4岁)。方法受试者仰卧,清醒,采用表面电极以50mA强度、波宽0.2ms的方波刺激左眶上神经、左正中神经、左胫神经,表面电极于双手掌心和双足心记录SSR,记录并分析SSR引出率、潜伏期和波幅。结果:完全性SCI患者3处刺激四肢记录SSR引出率均降低(与正常组比较p<0.05)。T6以上完全性损伤的患者,3处刺激均不能引出四肢的SSR,T6-T11患者能引出SSR者其波形和潜伏期与正常对照组均无显著差异(p>0.05)。不完全性SCI患者左胫神经刺激双足心记录时SSR引出率降低(p<0.05)。不完全性SCI的患者可引出SSR者,左正中神经刺激左掌心记录与正常对照组之间有显著差异(p<0.05)。双掌心记录到异常SSR的SCI患者中有50%的有过自主神经反射障碍(AD)发作史。结论:SCI患者中的SSR异常、且比正常人减弱或不能引出。SSR可作为评估不同平面与损害程度SCI患者的自主神经功能方法之一,尤其是交感神经的脊髓中枢完整性评估。双手心记录的SSR异常SCI患者,与其是否发生过AD可能有一定的关系。更多还原

【Abstract】 Objectives:The aim of this study is to find out the different features of sympathetic skin response(SSR) between the patients with spinal cord injury(SCI) and normal subjects. The SSR may be a new objective method to assess the integrity of spinal autonomic nervers (especially for sympathetic system) in the patients with SCI.Subjects and methods:Subjects Twenty chronic patients with SCI in different levels (neural level: range C5 to L3) and degrees (AIS: range A to D) were involved in the SSR testing. They were 16 male and only 4 female whose average age is 37±14(15~59) years. The duration for SCI onset was 2 weeks to 9 months. Meanwhile, 20 normal subjects(11 male and 9 female) were tested as the control group.methods All subjects lie supine on the bed with the electrical stimulation in left supra orbital, median and tibial nerve respectively. At the same time, the record electrodes were set at the bilateral palms of two hands and soles of feet. The the shape, amplitude and lantency of SSR were analyzed in each group.Results:No matter where the electrode on , the detection rate of SSR in patient with complete spinal cord injury decreased(p<0.05). SSR could not be recorded in the patients with complete SCI above level T6 by stimulating left supra orbital, median and tibial nerve, respectively. There was no significant difference between control group and complete spinal cord injury group with T6 to T11(p>0.05). The rates of response at sole-SSR decreased when stimulated left tibial nerve in the patients with incomplete SCI(p<0.05). There was a significant difference between control group and incomplete spinal cord injury group when considering about initial latency and amplitude by stimulating left median never(p<0.05). Otherwise, nearly 50 percent of the patients with abnormal palm SSRs had one autonomic dysreflexia episode history.Conclusion:SSR of the patients with chronic SCI were abnormal and even disapeared by comparing with control group. We may apply the SSR to assess the impact of the autonomic nerve system, particularly for the sympathetic systems after spinal cord injury.更多还原