中国医学前沿杂志（电子版）
中國醫學前沿雜誌（電子版）
중국의학전연잡지（전자판）
Chinese Journal of the Frontiers of Medical Science (Electronic Version)
2015年
9期
23-25
,共3页
肌萎缩侧索硬化%临床诊治
肌萎縮側索硬化%臨床診治
기위축측색경화%림상진치
Amyotrophic lateral sclerosis%Clinical diagnosis and treatment
目的：探讨肌萎缩侧索硬化（amyotrophic lateral sclerosis，ALS）的临床诊治要点，为制订临床诊治方案提供参考。方法回顾性分析本院2011年1月至2014年1月收治的41例ALS患者的临床资料，分析起病情况、主要临床表现、治疗情况以及随访结果，探讨ALS的临床诊治策略。结果87.80%的患者为隐袭发病，78.05%的患者首发症状为肌无力，60.97%的患者发病部位为上肢，46.34%的患者表现为上肢肌无力，65.85%的患者有肌肉震颤表现，上肢肌萎缩（19.51%）、下肢肌萎缩（12.20%）和全身肌肉萎缩（12.20%）较常见。颅神经损害以舌咽、迷走神经损害（14.63%）常见，65.85%的患者表现为肌张力减低，65.85%的患者表现为锥体束损害。所有患者肌电图检查结果均提示神经源性损害；患者平均住院时间为（25.38±10.51）天；死亡1例，37例患者的病情好转后出院，3例带呼吸机出院。随访结果显示，40例患者中，5例病情无明显进展，30例病情进展，5例病情加重死亡。结论 ALS是一种诊断和治疗难度较大的神经系统疾病，临床医师应全面评估患者的症状、体征、肌电图等检查结果，尽早明确诊断并治疗，以改善患者预后。
目的：探討肌萎縮側索硬化（amyotrophic lateral sclerosis，ALS）的臨床診治要點，為製訂臨床診治方案提供參攷。方法迴顧性分析本院2011年1月至2014年1月收治的41例ALS患者的臨床資料，分析起病情況、主要臨床錶現、治療情況以及隨訪結果，探討ALS的臨床診治策略。結果87.80%的患者為隱襲髮病，78.05%的患者首髮癥狀為肌無力，60.97%的患者髮病部位為上肢，46.34%的患者錶現為上肢肌無力，65.85%的患者有肌肉震顫錶現，上肢肌萎縮（19.51%）、下肢肌萎縮（12.20%）和全身肌肉萎縮（12.20%）較常見。顱神經損害以舌嚥、迷走神經損害（14.63%）常見，65.85%的患者錶現為肌張力減低，65.85%的患者錶現為錐體束損害。所有患者肌電圖檢查結果均提示神經源性損害；患者平均住院時間為（25.38±10.51）天；死亡1例，37例患者的病情好轉後齣院，3例帶呼吸機齣院。隨訪結果顯示，40例患者中，5例病情無明顯進展，30例病情進展，5例病情加重死亡。結論 ALS是一種診斷和治療難度較大的神經繫統疾病，臨床醫師應全麵評估患者的癥狀、體徵、肌電圖等檢查結果，儘早明確診斷併治療，以改善患者預後。
목적：탐토기위축측색경화（amyotrophic lateral sclerosis，ALS）적림상진치요점，위제정림상진치방안제공삼고。방법회고성분석본원2011년1월지2014년1월수치적41례ALS환자적림상자료，분석기병정황、주요림상표현、치료정황이급수방결과，탐토ALS적림상진치책략。결과87.80%적환자위은습발병，78.05%적환자수발증상위기무력，60.97%적환자발병부위위상지，46.34%적환자표현위상지기무력，65.85%적환자유기육진전표현，상지기위축（19.51%）、하지기위축（12.20%）화전신기육위축（12.20%）교상견。로신경손해이설인、미주신경손해（14.63%）상견，65.85%적환자표현위기장력감저，65.85%적환자표현위추체속손해。소유환자기전도검사결과균제시신경원성손해；환자평균주원시간위（25.38±10.51）천；사망1례，37례환자적병정호전후출원，3례대호흡궤출원。수방결과현시，40례환자중，5례병정무명현진전，30례병정진전，5례병정가중사망。결론 ALS시일충진단화치료난도교대적신경계통질병，림상의사응전면평고환자적증상、체정、기전도등검사결과，진조명학진단병치료，이개선환자예후。
ObjectiveTo investigate the clinical diagnosis and treatment of amyotrophic lateral sclerosis (ALS) and provide reference for the diagnosis and treatment.MethodThe clinical data of 41 patients with ALS from January 2011 to January 2014 in our hospital were retrospectively analyzed. The main clinical feature, treatment and follow-up results were analyzed, to investigate the clinical diagnosis and treatment strategy of ALS.Result87.80% of patients with insidious onset, the ifrst symptom of 78.05% for myasthenia gravis, 60.97% of the patients were upper limb disease; 46.34% of patients with upper limb myasthenia and 65.85% of patients with muscle tremor, upper limb amyotrophy (19.51%), lower limb amyotrophy (12.20%) and systemic amyotrophy (12.20%) were more common. Glossopharyngeal nerve and vagus nerve damage (14.63%) were more common, 65.85% of patients showed dysmyotonia, 65.85% of patients showed pyramidal tract damaged. EMG results of all patients showed neurogenic damage; average length of hospital stay was (25.38±10.51) days, 1 case died, 37 cases with condition improved after discharge, 3 cases with ventilator. The follow-up results showed that there were no obvious progress in 5 cases, 30 cases of disease progress, 5 cases of exacerbations occurred death.ConclusionALS is a kind of nervous system disease, dififcult to diagnose and treat, clinicians should comprehensively assess symptoms, signs, EMG and other examination results, as soon as possible to diagnose and treat, to improve the prognosis of patients.
