高频外部肌肉刺激对尿毒症性周围神经病变症状及电生理参数的影响

The effect of high-tone external muscle stimulation on symptoms and electrophysiological parameters of uremic peripheral neuropathy.

作者信息

Strempska Beata, Bilinska Malgorzata, Weyde Waclaw, Koszewicz Magdalena, Madziarska Katarzyna, Golebiowski Tomasz, Klinger Marian

机构信息

Department of Nephrology and Transplantation Medicine, and Department of Neurology, Medical University, Wrocław, Poland.

出版信息

Clin Nephrol. 2013 Jan;79 Suppl 1:S24-7.

PMID:23249529

Abstract

OBJECTIVE AND DESIGN

Peripheral neuropathy is a devastating uremic complication that causes debilitating pain and movement limitation. The aim of the study was to assess the influence of high-tone external muscle stimulation (HTEMS) therapy on clinical and electrophysiologycal parameters in hemodialysis patients with uremic peripheral neuropathy.

PATIENTS AND INTERVENTIONS

The study group consisted of 28 chronic hemodialysis patients (mean age 71.6 ± 8.6 y, median 74 y) on maintenance dialysis for 3 - 187 months (median 31 months). Eight persons (28.9%) were diabetics. All of them exhibited overt peripheral neuropathy and had undergone pharmacological therapy without improvement. All subjects were treated with HTEMS for 1 h during a hemodialysis session, 3 times weekly for 12 weeks. The dialysis parameters (duration of the session, blood and dialysate flow) were constant during the treatment period. Electrophysiological evaluation before and after intervention included assessment of sensory nerves (ulnar nerve, sural nerve) and motor nerves (ulnar nerve, peroneal nerve). The examined nerve conduction parameters were conduction velocity, amplitude, distal latency and F-wave latency.

RESULTS

In the questionnaire 18 persons (64%) reported improvement of general well-being after HTEMS therapy, 17 persons (61%) felt an increase of physical capacity, and 16 persons (57%) experienced a decreased feeling of cold feet. The electrophysiological findings were obtained in 19 patients who completed the examination before and after the course of HTEMS. A significant improvement was noted in the motor conduction velocity of the ulnar nerve; respective values were 48.53 ± 6.14 vs. 51.50 ± 5.51 m/s, p = 0.03.

CONCLUSION

The study demonstrated for the first time that the subjective amelioration of uremic peripheral neuropathy by HTEMS treatment is associated with significant improvement in an objective electrophysiological parameter, motor conduction velocity of the ulnar nerve.

摘要

目的与设计

周围神经病变是一种严重的尿毒症并发症，可导致使人衰弱的疼痛和运动受限。本研究的目的是评估高音调外部肌肉刺激（HTEMS）疗法对尿毒症周围神经病变血液透析患者临床和电生理参数的影响。

患者与干预措施

研究组由28例维持性血液透析患者组成（平均年龄71.6±8.6岁，中位数74岁），维持透析3 - 187个月（中位数31个月）。8人（28.9%）为糖尿病患者。他们均表现出明显的周围神经病变，且接受过药物治疗但无改善。所有受试者在血液透析期间接受HTEMS治疗1小时，每周3次，共12周。治疗期间透析参数（透析时间、血液和透析液流量）保持恒定。干预前后的电生理评估包括对感觉神经（尺神经、腓肠神经）和运动神经（尺神经、腓总神经）的评估。所检测的神经传导参数为传导速度、波幅、远端潜伏期和F波潜伏期。

结果

在问卷调查中，18人（64%）报告HTEMS治疗后总体幸福感有所改善，17人（61%）感觉身体能力增强，16人（57%）感觉脚部寒冷感减轻。19例患者在HTEMS疗程前后完成了检查并获得了电生理结果。尺神经运动传导速度有显著改善；相应值分别为48.53±6.14与51.50±5.51 m/s，p = 0.03。