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參考電極位置及主記錄電極面積影響誘複合肌肉動作電位之定量分析研究

Quantitative Analysis of The Effect of Reference Electrode Position and Active Recording Electrode Size on Evoked Compound Muscle Action Potential

摘要


本文之目的在以定量方法檢視正中神經及尺神經檢查時,其參考電極位置的改變及主記錄電極面積的變化對誘發複合肌肉動作電位(CMAP)之影響。於21位年輕正常受試者,分別在腕部施予正中神經及尺神經之超大電量刺激,同時在短外展拇指肌與外展小指肌作CMAP之記錄。復於40位年輕受測者實施主記錄電極改變後CMAP之測試。利用電腦判讀分析其表面積、振幅、間期及潛期的變化。結果發現:I)正中神經檢查時 (a)參考電極由拇指掌指關節移至指間關節或第五掌指關節時,其CMAP之表面積,振幅均明顯的降低,間期及潛期則無改變;(b)主記錄電極改為單極針記錄時,CMAP之振幅顯著升高,但表面積、間期及潛期沒有變化;(c)主記錄電極改為方形記錄電極時,CMAP之表面積、振幅及間期均顯著下降,潛期則無變化。Ⅱ)尺神經檢查時(a)參考電極由小指掌指關節移至遠端指間關節時,其CMAP之表面積及間期均顯著下降,但振幅及潛期無明顯變化;(b)參考電極由小指掌指關節移至拇指掌指關節時,其CMAP之表面積及振幅均下降,間期及潛期則無影響;(c)主記錄電極改為單極針或方形記錄電極,則對CMAP之表面積、振幅、間期及潛期的改變皆無統計學上的意義。本文同時討論造成各項變化之可能成因。

並列摘要


The purpose of this study is to quantitatively analyze the effect of reference electrode size on the amplitude, surface area, latency and duration of CMAP during routine NCV studies in median and ulnar nerves. We dilivered supramaximal stimulations over the wrist in the median and ulnar nerve examinations and obtained the data of CMAP parameters from APB and ADQ muscles. The data revealed: I)in median nerve examination: (1) The CMAP surface area and amplitude decreased markedly when the reference electrode was shifted from MP joint to IP joint of the thumb or to MP joint of the 5th finger. (2) The CMAP amplitude increased significantly when the monopolar needle was used as the active recording electrode. (3)The CMAP amplitude and surface area decreased when the active recording electrode to tin plate electrode. Ⅱ) in ulnar nerve examination: (1) The CMAP surface area and duration decreased when the reference electrode was shifted from MP joint to DIP joint of the 5th finger. (2) The surface area and amplitude were smaller when the reference electrode was in the MP joint of the thumb. (3) There was no significant difference in amplitude, surface area, duration and latency with the different sizes of active recording electrode.

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