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目的观察经积极治疗后的严重正己烷中毒性周围神经病患者的电生理变化规律,探讨预后。方法随访经积极治疗的16例严重正己烷中毒性周围神经病患者,依次在治疗前和治疗后第1、3、9、24个月对其右侧大鱼际肌、胫前肌及股内肌进行肌电图检查,测定其右侧正中神经、腓总神经和腓肠神经进行神经传导速度,分析肌电图和神经传导速度各参数的变化规律。结果严重正己烷中毒性周围神经病患者电生理表现为肌肉放松时自发电位增多(25.0%),轻收缩时运动单位电位时限延长(20.8%)、波幅增高(12.5%)、多相波增多(16.5%),重收缩时募集减少(25.0%);神经传导速度(MCV、SCV)减慢、感觉神经动作电位(SNAP)和复合肌肉动作电位(CMAP)波幅下降、远端潜伏期(DML)延长,其中正中神经:MCV(46.00±4.32)m/s、SCV(40.66±2.65)m/s、SNAP(7.98±1.05)μV、DML(4.28±0.63)ms、CMAP(6.32±1.54)mV,腓总神经:MCV(34.96±2.55)m/s、CMAP(3.21±1.99)mV、DML(7.32±1.65)ms,腓肠神经:SCV(36.48±5.20)m/s、SNAP(2.15±1.22)μV;而正常对照组的正中神经:MCV(54.63±5.33)m/s、SCV(59.25±6.45)m/s、SNAP(26.53±6.32)μV、DML(3.96±0.65)ms、CMAP(9.89±2.30)mV,腓总神经:MCV(48.49±3.25)m/s、CMAP(5.47±1.77)mV、DML(5.20±3.27)ms,腓肠神经:SCV(63.21±9.30)m/s、SNAP(4.63±1.29)μV;两组各指标的差异均有统计学意义(均P<0.01);经积极治疗后,正己烷中毒患者以上各项参数均逐渐好转,24个月后基本恢复正常。结论严重正己烷中毒性周围神经病患者电生理表现明显异常,经积极治疗后,电生理指标可望恢复正常,临床预后良好。
Objective To observe the electrophysiological changes of patients with severe n-hexane toxic peripheral neuropathy after active treatment and explore the prognosis. Methods Sixteen patients with severe n-hexane toxic peripheral neuropathy underwent active follow-up. The right major intermuscular muscle, anterior tibial muscle and intramuscular muscle were examined before and after treatment at 1, 3, 9 and 24 months Electromyography was performed to measure the nerve conduction velocity of the right median nerve, common peroneal nerve and sural nerve. The changes of EMG and nerve conduction velocity parameters were analyzed. Results Electroencemographic findings in patients with severe n-hexane toxic peripheral neuropathy showed an increase in spontaneous potentials (25.0%) in muscle relaxation, an increase in duration of motor unit potentials (20.8%), an increase in amplitude (12.5%) and an increase in polyphase waves (16.5 (P <0.05), decreased recruitment (25.0%) during re-contraction, decreased nerve conduction velocity (MCV, SCV), decreased amplitude of sensory nerve action potential (SNAP) and compound muscle action potential (CMAP), prolonged distal latency (DML) The median nerve: MCV (46.00 ± 4.32) m / s, SCV (40.66 ± 2.65) m / s, SNAP (7.98 ± 1.05) μV, DML (4.28 ± 0.63) ms and CMAP Nerves: MCV (34.96 ± 2.55) m / s, CMAP (3.21 ± 1.99) mV, DML (7.32 ± 1.65) ms and sural nerve SCV (36.48 ± 5.20) m / While the median nerve of MCV (54.63 ± 5.33) m / s, SCV (59.25 ± 6.45) m / s, SNAP of 26.53 ± 6.32 μV, DML of 3.96 ± 0.65 ms, CMAP of 9.89 ± 2.30, mV, and the common peroneal nerve were respectively MCV (48.49 ± 3.25) m / s, CMAP (5.47 ± 1.77) mV, DML (5.20 ± 3.27) ms and sural nerve SCV (63.21 ± 9.30) m / 1.29) μV; There were significant differences between the two groups (all P <0.01). After active treatment, n-hexane poisoning The above parameters are getting better, after 24 months returned to normal. Conclusion Severe n-hexane toxic peripheral neuropathy patients with abnormal electrophysiological manifestations, after active treatment, the electrophysiological indicators are expected to return to normal, the clinical prognosis is good.