卒中患者手功能与桡动脉血供及交感神经皮肤反应的相关性分析

Correlation between hand function and radial artery blood supply and sympathetic skin response in stroke patients

摘要:

目的：通过桡动脉彩超及双上肢的交感神经皮肤反应（sympathetic skin response，SSR）测定，了解卒中患者上肢瘫痪程度与其血流灌注及交感神经活性的相关性。方法：将74例Brunnstrom’s评分<3分的脑卒中患者纳入研究，利用Fugl-Meyer 运动功能量表（Fugl-Meyer assessment，FMA）评估其上肢功能；超声测定双侧桡动脉的收缩期峰值流速（peak systolic velocity，PSV）、舒张期末流速（end diastolic velocity，EDV）、管径（diameter）、血容量（blood flow volume，BFV）及阻力指数（resistance index，RI），同时测定双侧正中神经的SSR。通过Pearson相关系数（r值）分析患肢瘫痪程度与血流灌注及SSR之间的相关性。结果：①卒中患者瘫痪侧桡动脉的BFV、EDV低于正常侧肢体（P=0.003）。②卒中患者瘫痪侧桡动脉的RI低于正常侧肢体（P=0.015）。③患肢SSR波幅较健侧为低（P=0.027），潜伏期无明显差异。④FMA评分与患/健侧桡动脉BFV比值呈正相关（r=0.712，P=0.046），与SSR波幅呈正相关（r=0.455，P=0.032）。结论：患肢的血流灌注较健侧明显减少，且随肢体功能障碍程度呈加重趋势。偏瘫上肢存在一定程度的交感调节机制障碍，但SSR作为交感神经功能的一个评估指标，难以准确反映桡动脉的功能状态。

Abstract:

Objective：To determine the correlation between the paralytic degree of upper limbs and blood perfusion and sympathetic nerve activity in stroke patients by radial artery color Doppler ultrasound and sympathetic skin response（SSR） measurements of the upper limbs. Methods：74 stroke patients with Brunnstrom’s score<3 were included in the study，and their upper limb function was assessed using the Fugl-Meyer assessment（FMA）. Peak systolic velocity（PSV），end diastolic velocity（EDV），diameter，blood flow volume（BFV），and resistance index（RI） were determined by ultrasound，and at the same time the SSR of the bilateral median nerve was determined. Pearson correlation coefficient（r value） was used to analyze the correlation between the paralytic degree of affected limbs and blood perfusion and SSR. Results：①The BFV and EDV of radial artery in the affected limb of stroke patients was smaller than those in the healthy limb（P=0.003）. ②The RI of radial artery in the affected limb was lower than that in the healthy limb（P=0.015）. ③The amplitude of SSR in the affected limb was lower than that in the healthy limb，but there was no obvious difference in incubation period. ④The FMA score was positively correlated with the ratio of the radial-artery BFVs in the affected and the healthy limb（r=0.712，P=0.046），and positively correlated with the amplitude of SSR（r=0.455，P=0.032）. Conclusions：Compared with the healthy limb，the blood perfusion of the affected limb was significantly reduced and the degree of limb dysfunction was aggravated. There is a certain degree of sympathetic regulation disorder in the paralytic upper limbs. However，as an evaluation index of sympa－thetic function，SSR amplitudes can’t reveal the condition of radial artery accurately.