Erb 点刺激在儿童吉兰-巴雷综合征早期诊断中的作用

Role of nerve stimulation at Erb point in early diagnosis of Guillain-Barré syndrome in children

摘要:

目的 探讨Erb 点刺激在儿童吉兰-巴雷综合征(GBS)早期诊断中的作用。方法 选取2013年10 月至2014 年12 月诊断为GBS 的32 例患儿进行神经电生理检查,同期选取30 例健康儿童为对照组,检测并分析两组正中神经和尺神经的腕部、肘部、Erb 点刺激复合肌肉动作电位(CMAP)及末端运动传导潜伏期(DML),正中神经F 波潜伏期,以及胫神经H 反射潜伏期。结果 病例组F 波和H 反射潜伏期均明显长于对照组(P<0.05)。32 例患儿中,24 例Erb 点波幅异常(75%),22 例Erb 点潜伏期异常(69%),20 例Erb 点传导阻滞(62%),病例组尺神经、正中神经 Erb 点CMAP 均小于对照组,而DML 均长于对照组(P<0.05);两组腕部和肘部的CMAP 及DML 差异无统计学意义(P>0.05)。结论 Erb 点刺激在GBS 早期诊断中有一定价值,可作为一项常规检查应用于GBS 的早期诊断。

Abstract:

Objective To study the role of proximal nerve stimulation at Erb point in the early diagnosis of Guillain-Barré syndrome (GBS) in children. Methods Thirty-two children who were diagnosed with GBS between October 2013 and December 2014 received neurophysiological examination. Thirty healthy children were used as controls. Compound muscle action potentials and distal motor latency of the median and ulnar nerves were determined and analyzed after nerve stimulation at the wrist, elbow, and Erb point in the two groups. Moreover, F-wave latency of the median nerve and H-reflex latency of the tibial nerve were measured and analyzed in the two groups. Results The F-wave and H-reflex latencies were significantly longer in the patient group than in the control group (P<0.05). In thirty-two patients, the numbers of patients with abnormal amplitude, abnormal latency, and conduction block at Erb's point were 24 (75%), 22 (69%), and 20 (62%), respectively. The patient group had significantly lower amplitudes but significantly longer latencies of the ulnar and median nerves at Erb point than the control group (P<0.05). There were no significant differences in the amplitudes and latencies at the wrist and elbow between the two groups (P>0.05). Conclusions The nerve stimulation at Erb point holds promise as a routine examination for the early diagnosis of GBS.