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目的观察比较脑性瘫痪(脑瘫)患儿与正常儿童多焦视觉诱发电位(mf VEP)振幅与潜伏期的变化。方法脑瘫组为四川大学华西第二医院儿童神经康复科及成都市中西医结合医院儿童康复科2009年-2013年收治的脑瘫(单肢瘫痪)儿童14例(年龄4~7岁)。对照组为同一时期就诊于四川大学华西医院眼科的正常儿童14例(年龄5~9岁)。所有受试者的双眼均进行mf VEP检查,mf VEP检查结果中的振幅与潜伏期用于数据分析。首先分析14例脑瘫患儿与对照组之间的波形(潜伏期、振幅)差异;应用粗大运动功能分级系统(GMFCS)分级标准对14例脑瘫患儿进行分级:5例患儿为GMFCSⅠ级,9例患儿为GMFCSⅡ级;比较不同级别的脑瘫患儿之间mf VEP的差异。结果脑瘫组的mf VEP波形变化趋势与对照组类似:其振幅从离心度第1环至第6环逐渐下降,其潜伏期则逐渐延长。与对照组相比,脑瘫组在第1环至第3环左、右眼振幅下降,差异有统计学意义(P<0.05)。脑瘫组左眼潜伏期在第1环延长,差异有统计学意义(P=0.045)。比较脑瘫儿童GMFCSⅠ级组与GMFCSⅡ级组,发现两组间振幅在第1环上差异具有统计学意义(P=0.043),其他结果差异无统计学意义(P>0.05)。结论通过多焦视觉电生理技术,发现脑瘫患儿mf VEP波与对照组之间存在差异,提示脑瘫患儿存在视觉通路损害。mf VEP的结果为揭示脑瘫患儿视觉障碍提供客观的理论依据。
Objective To observe the changes of amplitude and latency of mf VEP in children with cerebral palsy (CP) and normal children. Methods Cerebral palsy group was 14 children (4 to 7 years old) with cerebral palsy (single limb paralysis) who were admitted to Department of Neurology and Rehabilitation, West China Second Hospital, Sichuan University, and Children’s Rehabilitation Department of Chengdu Integrative Medicine Hospital from 2009 to 2013. Control group was treated in the same period in West China Hospital of Sichuan University, 14 cases of normal children (aged 5 to 9 years old). All subjects had mf VEP in both eyes and amplitude and latency in mf VEP findings were used for data analysis. First of all, the differences of the waveforms (latency and amplitude) between 14 children with cerebral palsy and the control group were analyzed. Fourteen children with cerebral palsy were classified according to GMFCS grading standards. Five children were GMFCSⅠ, Cases of children with GMFCS Ⅱ level; comparison of different levels of children with cerebral palsy mf VEP differences. Results The trend of mf VEP waveform in cerebral palsy group was similar to that in control group. The amplitude decreased from the first to the sixth ring of the eccentricity, and the latency gradually increased. Compared with the control group, the amplitude of left and right eyes in the cerebral palsy group decreased from the first ring to the third ring, the difference was statistically significant (P <0.05). The left eye latency of cerebral palsy group was prolonged in the first ring, the difference was statistically significant (P = 0.045). Comparing children with cerebral palsy GMFCSⅠstage and GMFCSⅡstage, the difference between the two groups was statistically significant (P = 0.043). There was no significant difference in other results (P> 0.05). Conclusion Multifocal visual electrophysiological techniques showed that there was a difference between mf VEP wave and control group in children with cerebral palsy, suggesting that visual impairment exists in children with cerebral palsy. mf VEP results provide an objective theoretical basis for revealing visual impairment in children with cerebral palsy.