| 李红玲,徐凌娇,潘拴珍,王淑英.脑卒中后偏瘫患者下肢H反射的特征表现[J].中国康复医学杂志,2011,26(11):1051~1055 |
| 脑卒中后偏瘫患者下肢H反射的特征表现 点此下载全文 |
| 李红玲 徐凌娇 潘拴珍 王淑英 |
| 河北医科大学第二医院，石家庄，050000 |
| 基金项目： |
| DOI： |
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| 摘要
目的：通过研究脑卒中后偏瘫患者下肢H反射的特征表现及其与偏瘫下肢肢体功能评定的关系，探讨H反射在脑卒中后偏瘫患者神经电生理评定中的应用价值。
方法：选择脑卒中恢复期偏瘫患者40例，分别对患者双侧胫神经和腓总神经所支配的腓肠肌和胫骨前肌进行H反射检查，并对患侧下肢给予临床痉挛指数(CSI)评定。计算胫神经和腓总神经H反射的引出率，并对其所引出的H反射结果以及与CSI的相关性进行比较和分析。
结果：患者双侧胫神经所支配的腓肠肌H反射引出率100%，胫骨前肌H反射引出率为10%。患侧胫神经H反射潜伏期平均为（30.09±1.87）ms；非患侧胫神经H反射潜伏期平均为（31.99±2.31）ms。患侧胫神经Hmax/Mmax比值均数中位数平均为0.476；非患侧胫神经Hmax/Mmax比值平均为0.189。患侧与非患侧相比，患侧H反射潜伏期缩短，Hmax/Mmax比值增大，且差异有显著性意义（P<0.05）。将患侧下肢胫神经H反射潜伏期分别与CSI进行Spearman秩相关检验，结果显示患侧下肢胫神经H反射潜伏期与CSI不相关，而患侧下肢胫神经Hmax/Mmax比值与CSI存在秩相关关系。
结论：用H反射来评价脑卒中后偏瘫患者患侧痉挛的存在和严重程度，比CSI量表更客观、量化。其中Hmax/Mmax比值是评估下运动神经元兴奋性的较好指标。 |
| 关键词：脑卒中 偏瘫下肢 H反射 痉挛 评定 |
| The characteristic appearance and analysis of H reflex in lower extremity of hemiplegic patients with post-stroke Download Fulltext |
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| The Second Hospital Affiliatecl to Hebei Medical University, No.215, Heping Xi Rood, Shijiazhuang City, 050000 |
| Fund Project: |
| Abstract: |
| Abstract
Objective: To investigate the value of application of H reflex in electrophysiological evaluation by studying relationship between the characteristic appearance of H reflex and functional assessment of affected lower extremity of hemiplegic patients post-stroke.
Method: Forty hemiplegic inpatients in post-stroke convalescence stage were in various severities of limb dysfunction. The H reflex examination was administered on gastrocnemius (GS) innervated by tibial nerve and tibialis anterior (TA) innervated by common peroneal nerve of patients' extremities of both sides. At the same time, affected lower extremity was assessed with clinic spasticity index (CSI) to measure the elicitation rate of H reflex from both nerves mentioned above. and to compare the changes of H reflex latency and ratio of maximum amplitude of H reflex to that of maximum compound action motor potential (Hmax/Mmax) of both sides and to the correlation between CSI and the H reflex latency or Hmax/Mmax ratio in affected lower extremities.
Result: H reflex could be easily elicitated from GS innervated by tibial nerve of both sides and the elicitation rate was 100%. But elicitation rate of TA innervated by common peroneal nerve was 10.0% only. The mean (SD) latencies of H reflex of the tibial nerve of affected sides were (30.09±1.87)ms and that of unaffected sides were (31.99±2.31)ms. The median of Hmax/Mmax ratio value for tibial nerve of affected sides was 0.476 and that of unaffected sides was 0.189. The H reflex latency shortened and the Hmax/Mmax ratio increased in affected side compared with those in unaffected sides for tibial nerve, and the differences of both sides were statistically significant(P<0.05). By using Spearman rank test, the Hmax/Mmax ratio (rs=0.611, P=0.000<0.05) for tibial nerve in affected lower extremity had a rank correlation with CSI, while the H reflex latency (rs=-0.322, P=0.071＞0.05) did not.
Conclusion: In a word, the existence and severity of spasticity of affected side in hemiplegic patients post-stroke can be evaluated with H reflex more objectively and quantitatively compared with CSI. And the Hmax/Mmax ratio is a better index for the assessment of excitability of lower motor neurons of affected side in hemiplegic patients post-stroke. |
| Keywords:stroke hemiplegic lower extremity H reflex spasticity evaluation |
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