CAJ | 학술논문

目的：本研究通过经皮神经电刺激(PNS)定位肘正中神经与高分辨率超声实时影像的对比观察,判定影响 PNS 最小电流强度的相关因素。方法本研究采用前瞻性观察方法,纳入40例健康成年志愿者,使用 PNS 电刺激笔在2 Hz、0.2 ms、初始电流强度3 mA 探头模式下定位肘正中神经,根据肌缩结果调整电流大小,记下引起肌缩反应的最小电流强度。随后,在 PNS 定位点使用高分辨率超声观察并记录肘正中神经距皮肤的垂直距离、神经的直径、面积及周长。结果 PNS 定位肘正中神经最小电流强度为(1.9±0.6)mA,肘正中神经距皮肤的垂直距离即神经深度为(6.1±1.7)mm。肘正中神经深度与最小电流强度的线性回归方程：Y(神经深度)=0.359+0.135X1(最小电流强度),决定系数 R2=0.251(P <0.01)。结论神经深度是决定最小电流强度的主要因素,最小电流强度大小与神经深度呈线性相关,提示 PNS 不仅能判定外周神经的位置,而且根据 PNS 测定的最小电流强度还有助于预判外周神经的深度以期减少穿刺操作盲目性。
목적：본연구통과경피신경전자격(PNS)정위주정중신경여고분변솔초성실시영상적대비관찰,판정영향 PNS 최소전류강도적상관인소。방법본연구채용전첨성관찰방법,납입40례건강성년지원자,사용 PNS 전자격필재2 Hz、0.2 ms、초시전류강도3 mA 탐두모식하정위주정중신경,근거기축결과조정전류대소,기하인기기축반응적최소전류강도。수후,재 PNS 정위점사용고분변솔초성관찰병기록주정중신경거피부적수직거리、신경적직경、면적급주장。결과 PNS 정위주정중신경최소전류강도위(1.9±0.6)mA,주정중신경거피부적수직거리즉신경심도위(6.1±1.7)mm。주정중신경심도여최소전류강도적선성회귀방정：Y(신경심도)=0.359+0.135X1(최소전류강도),결정계수 R2=0.251(P <0.01)。결론신경심도시결정최소전류강도적주요인소,최소전류강도대소여신경심도정선성상관,제시 PNS 불부능판정외주신경적위치,이차근거 PNS 측정적최소전류강도환유조우예판외주신경적심도이기감소천자조작맹목성。
Objective Observed by ultrasound,this study investigated anatomical characters of median nerve affecting the minimal current intensity of percutaneous electrical nerve stimulation (PNS).Methods Forty healthy adult volunteers were enrolled in this prospective observational stud-y.PNS was performed with a stimulating pen in 2 Hz,0.2 ms,3 mA probe mode for cubits the me-dian nerve localization.Stimulation current was adjusted according to the motor response and the min-imal current intensity at which the motor response was obtained was recorded.There after,the medi-an nerve was observed with ultrasound imaging at the location point.Then,the depth,diameter,area and circumference of the nerve were determined.Results The minimal current intensity was (1.9 ± 0.6)mA and the depth of nerve was (6.1±1.7)mm.The linear regression equation between the mini-mal current intensity and the depth of nerve is:Y (nerve depth,cm)=0.359 +0.135X1 (minimum current intensity,mA),the determination coefficient R2 =0.25 1 (P <0.01).Conclusion The stimu-lation threshold of PNS localization the median nerve was correlated to the depth of nerve,which sug-gests that PNS not only can determine the position of the peripheral nerve,but also can help predict the depth of the peripheral nerve according to the minimum stimulus current.