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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。
Objective To investigate the characteristics of peripheral nerve conduction in patients with advanced amyotrophic lateral sclerosis (ALS) ventilator assisted ventilation. Methods The clinical data of 3 patients with advanced ALS with ventilator assisted ventilation were analyzed and the sensory nerve conduction velocity (SCV), motor nerve conduction velocity (MCV), end of motor extremity (DML) and amplitude of compound muscle action potential (CMAP) were measured. Results All three patients (12 motor nerves) had abnormal motor conduction function. 66.7% (8/12) did not lead to waveforms, 33.3% (4/12) CMAP amplitude was decreased and 16.7% (2/12) DML prolonged, 16.7% (2/12) MCV slowed down; and with prolonged course, the patient CMAP amplitude decreased gradually until the final lead no response. The amplitude of SCV and sensory nerve action potential (SNAP) in all patients were normal. Conclusions Patients with advanced ALS ventilator-assisted ventilation may have abnormal peripheral nerve conduction movement, but have little effect on sensory conduction. The specific mechanism needs to be further explored.