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目的:探讨节段和短段刺激尺神经后不同节段复合肌肉动作电位(CMAP)负波各参数变化及传导阻滞在吉兰-巴雷综合征(GBS)和慢性炎性脱髓鞘性周围神经病(CIDP)中的意义。方法:20例GBS和12例CIDP患者行尺神经5点分段刺激(腕、肘下、肘上、腋和Erb’s点)和短段刺激,记录CMAP负波波幅、时程和面积的变化,分析各参数与临床肌力的相关性。结果:在GBS中,尺神经CMAP负波的时程、波幅和面积的变化在Erb’s点到腕部的各节段中差异很大;波幅与面积的衰减与临床肌力呈高度相关(r=-0.905和-0.907);传导阻滞多见于近端和肘部,时程离散不明显。在CIDP中,各节段中的参数变化差异不大;远端波幅与临床肌力相关(r=0.586);传导阻滞在各节段均可出现,常伴明显的时程延长。结论:GBS和CIDP中尺神经CMAP负波的波幅、面积和时程3个参数,可从电生理角度帮助我们认识脱髓鞘疾病的特点。
OBJECTIVE: To investigate the changes of negative parameters of complex muscle action potential (CMAP) in different segments after segment and short segment stimulation of ulnar nerve and the relationship between conduction block and GBS and chronic inflammatory demyelination Peripheral neuropathy (CIDP) in the significance. Methods: 20 cases of GBS and 12 cases of CIDP underwent 5-point ulnar nerve stimulation (wrist, elbow, elbow, axillary and Erb’s point) and short-term stimulation. The amplitude, duration and area of CMAP were recorded. Analysis of the correlation between parameters and clinical muscle strength. Results: The time course, amplitude and area change of CMAP negative in the ulnar nerve varied greatly in Erb’s point to wrist. The attenuation of amplitude and area was highly correlated with clinical muscle strength (r = -0.905 and -0.907); conduction block more common in the proximal and elbow, time-discrete is not obvious. In CIDP, there was no significant difference in the parameters in each segment; distal amplitude was correlated with clinical muscular strength (r = 0.586); conduction block appeared in all segments, often accompanied by significant prolongation of time. CONCLUSION: The three parameters of amplitude, area and time-history of CMAP negative in midbrain nerve of GBS and CIDP can help us understand the characteristics of demyelinating disease from electrophysiological point of view.