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晚期肌萎缩侧索硬化症呼吸机辅助通气患者周围神经传导功能的观察
崔芳,黄旭升*,陈朝晖
0
(解放军总医院神经内科,北京 100853)
摘要:
目的 探讨晚期肌萎缩侧索硬化症(amyotrophic lateral sclerosis,ALS)呼吸机辅助通气患者周围神经传导的特点。方法 分析3例呼吸机辅助通气晚期ALS患者临床资料,测定感觉神经传导速度(SCV)、运动神经传导速度(MCV)、运动末端潜伏期(DML)和复合肌肉动作电位(CMAP)波幅。结果 3例患者(12条运动神经)周围神经运动传导功能测定均为异常,其中66.7%(8/12)未引出波形,33.3%(4/12)CMAP波幅减低,16.7%(2/12)DML延长,16.7%(2/12)MCV减慢;且随着病程延长,患者CMAP波幅逐渐下降,直至最终引不出反应。所有患者SCV及感觉神经动作电位(SNAP)波幅均正常。结论 晚期ALS呼吸机辅助通气患者可出现严重的周围神经运动传导异常,而对感觉传导影响不大,具体机制有待进一步探讨。
关键词:  肌萎缩侧索硬化症  神经传导  机械通气
DOI:10.3724/SP.J.1008.2010.0527
投稿时间:2010-04-15修订日期:2010-05-12
基金项目:解放军总医院苗圃基金(06MP08).
Peripheral nerve conduction in advanced-stage amyotrophic lateral sclerosis patients undergoing mechanical ventilation
CUI Fang, HUANG Xu-sheng*, CHEN Zhao-hui
(Department of Neurology, General Hospital of PLA, Beijing 100853, China)
Abstract:
Objective To study the characteristics of peripheral nerve conduction (PNC) in advanced-stage amyotrophic lateral sclerosis (ALS) patients undergoing mechanical ventilation. Methods The sensory conduction velocity(SCV), motor conduction velocity(MCV), distal motor latency(DML) and amplitude of compound muscle action potential(CMAP) were determined in three ALS patients undergoing mechanical ventilation. The clinical data and PNC characteristics of the patients were analyzed. Results The 12 motor nerves were abnormal in all the three patients, including absence of responsive wave (66.7%,8/12) , decreased amplitude of CMAP(33.3%,4/12), prolongation of DML(16.7%,2/12) and reduction of MCV(16.7%,2/12). The CMAP amplitude of patients gradually decreased with the progression of disease, and finally led to adverse reactions. The SCV and amplitude of sensory nerve action potential were normal in all the three patients. Conclusion ALS patients undergoing mechanical ventilation may have severely damaged motor nerve conduction, and their sensory nerve is generally not affected, with the specific reason remains to be further studied.
Key words:  amyotrophic lateral sclerosis  nerve conduction  mechanical ventilation