【摘要】 目的建立接触性热痛诱发电位的检测方法,并研究其在脑梗死患者痛觉功能检测中的应用。方法对100例健康志愿者和30例脑梗死患者进行检测,其中将健康志愿者按臂长分为3组:A组臂长56.0～65.0 cm(34例),B组臂长65.5～74.0 cm(35例),C组臂长74.5～83.0 cm(31例)。应用接触性热痛诱发电位刺激器于两个刺激强度水平(49.5℃和54.5℃)对上述对象鱼际肌、手背及前臂掌侧面进行刺激。受试者经热痛刺激3～5s后对刺激强度进行评级。记录位点为Cz和Pz。探讨刺激强度与疼痛分级间的关系以及脑诱发电位的主要成分,检测偏侧痛觉异常脑梗死患者的接触性热痛诱发电位、正中神经感觉传导速度及体感诱发电位。结果采用49.5℃和54.5℃2个强度水平刺激健康志愿者上述部位时,其疼痛分级结果如下,鱼际肌皮肤分别为(3.2±0.3)级和(4.4±0.5)级;手背皮肤为(5.0±0.7)级和(6.3±0.8)级;前臂掌侧面皮肤为(5.3±0.6)级和(7.2±0.5)级。在进行热痛刺激时,能记录到三个主要成分:Cz/N550、Cz/ P750和Pz/P1000,其中手背部位主要记录到Cz/N550、Cz/P750,大鱼际肌部位主要记录到Pz/P1000,前臂掌侧主要记录到Cz/N550、Cz/P750、Pz/P1000。脑梗死组患侧接触性热痛诱发电位消失或波形不清晰,但该侧正中神经感觉传导速度及体感诱发电位均正常。结论正常受试者均能引出稳定、可靠的接触性热痛诱发电位,该检查有助于客观评估脑梗死患者痛觉功能缺失情况。更多还原

【Abstract】 Objective To establish the method of contact heat evoked potential(CHEP)and to explore the value of this evoked potential in pain testing of patients with cerebral infarction.Methods A total of 100 healthy volunteers and 30 patients were examined.The healthy volunteers were divided into 3 groups according to the length of their arms:(Group A:56.0～65.0 cm ;Group B :65.5～74.0 cm ;Group C :74.5～83.0 cm).A recently de- veloped heat-foil technique with a rapid temperature rising rate at 70℃/s was used to elicit pain and contact heat e- voked potentials.Contact heat was delivered via one circular thermode(diameter 27 mm,area 573 mm~2)and set at two intensity levels(49.5℃and 54.5℃)to three body sites:the thenar eminence,the dorsum of hand and proximal volar forearm.The subjects were asked to rate the pain with numerical rating scale after each stimulus and CHEP was recorded from Cz and Pz.The association between stimulus intensities and pain rating was explored,the main compo- nents of the evuked potential were watched.CHEP,sensory conduction velocity(SCV)and somatosensory evoked potentials(SEP)were performed in patients with hemi-anesthesia caused by cerebral infarction.Results The pain intensity ratings were 3.2±0.3 and 4.4±0.5 at thenar eminence,5.0±0.7 and 6.3±0.8 at the dorsum of hand and 5.3±0.6 and 7.2±0.5 at the proximal volar forearm when the temperature of 49.5℃and 54.5℃was applied, respectively;Three components,Cz/N550,Cz/P750 and Pz/P1000,were identified in the evoked potentials.Cz/ N550 and Cz/P750 appeared when the dorsum of hand and proximal volar forearm were stimulated.In contrast,Pz/ P1000 could be identified when nociceptors of thenar eminence and proximal volar fbrearm were excited.In the pa- tients with cerebral infarction,CHEP disappeared or became abnormal on one side,while SCV and SEP were normal on that side.Conclusion It was suggested that CHEP could be elicited reliably in the controls.CHEP is helpful in the assessment of analgesia in patients with cerebral infarction.更多还原