密歇根神經(jīng)病變篩查表

1、HowtoUsetheMichiganNeuropathyScreeningInstrument密歇根神經(jīng)病變篩查表使用指南History病史Thehistoryquestionnaireisself-administeredbythepatient.Responsesareaddedtoobtainthetotalscore.Responsesof“yes”toitems1-3,5-6,8-9,11-12,14-15areeachcountedasonepoint.A“no”responseonitems7and13countsas1point.Item#4isameasureofimpai

2、redcirculationanditem#10isameasureofgeneralaestheniaandarenotincludedinscoring.Todecreasethepotentialforbias,allscoringinformationhasbeeneliminatedfromthepatientversion.病史調查表由病人自己填寫，回答將計入其篩查總分中，1-3,5-6,8-9,11-12,14-15題每回答一個“是”將加1分，7和13題每回答一個“否”將加1分，4和10題不計分。為了減少潛在的誤差，在病史調查表上將不出現(xiàn)得分信息。PhysicalAssessme

3、nt體格檢查Forallassessments,thefootshouldbewarm(30C).所有評估必須建立在足部溫度30C的基礎上FootInspection:Thefeetareinspectedforevidenceofexcessivelydryskin,callousformation,fissures,frankulcerationordeformities.Deformitiesincludeflatfeet,hammertoes,overlappingtoes,haluxvalgus,jointsubluxation,prominentmetatarsalheads,me

4、dialconvexity(Charcotfoot)and：足部檢查的項目包括：足部皮膚干燥程度、胼胝體、龜裂、潰瘍或畸形。畸形包括：扁平足、錘狀趾、重疊趾、足外翻、關節(jié)半脫位、拇外翻、夏科特關節(jié)和截肢。VibrationSensation:Vibrationsensationshouldbeperformedwiththegreattoeunsupported.Vibrationsensationwillbetestedbilaterallyusinga128Hztuningforkplacedoverthedorsumofthegreattoeontheboneyprominenceoft

5、heDIPjoint.Patients,whoseeyesareclosed,willbeaskedtoindicatewhentheycannolongersensethevibrationfromthevibratingtuningfork.Ingeneral,theexaminershouldbeabletofeelvibrationfromthehand-heldtuningforkfor5secondslongeronhisdistalforefingerthananormalsubjectcanatthegreattoe(e.g.examinersDIPjointofthefirs

6、tfingerversuspatientstoe).Iftheexaminerfeelsvibrationfor10ormoresecondsonhisorherfinger,thenvibrationisconsidereddecreased.Atrialshouldbegivenwhenthetuningforkisnotvibratingtobecertainthatthepatientisrespondingtovibrationandnotpressureorsomeotherclue.Vibrationisscoreda_1)衛(wèi)resStiftheexaminersensesthe

7、vibrationonhisorherfingerfor10or3)absent(novibrationdetection.)振動見：振動覺應在大拇趾上檢查，用128Hz音叉放在大拇趾遠端第一關節(jié)突起的上方進行雙側檢查，同時病人閉起眼睛，這時再詢問患者何時感覺不到音叉在振動了。通常，當患者不能感受到振動，而檢查者把音叉放在自己示指上仍能感受到音叉振動超過10秒鐘，那么就要考慮振動覺減退了，同時必須進行一個試驗來證實受檢者是否誠實反應確切的感受而非受暗示，即使用未振動的音叉來檢驗。振動覺將被記錄為1)正常檢查者感覺音叉振動的時間10秒；3)缺失受檢者未察覺振動的存在。Theanklereflex

8、eswillbeexaminedusinganappropriatereflexhammer(e.g.TrommerorQueensquare).Theanklereflexesshouldbeelicitedinthesittingpositionwiththefootdependentandthepatientrelaxed.Forthereflex,thefootshouldbepassivelypositionedandthefootdorsi-flexedslightlytoobtainoptimalstretchofthemuscle.TheAchillestendonshould

9、bepercusseddirectly.Ifthereflexisobtained,itisgradedaspresent.Ifthereflexisabsent,thepatientisaskedtoperformtheJend-rassicmaneuver(i.e.,hookingthefingerstogetherandpulling).ReflexeselicitedwiththeJendrassicmaneuveralonearedesignated“presentwithreinforcement.”Ifthereflexisabsent,eveninthefaceoftheJen

10、drassicmaneuver,thereflexisconsideredabsent.肌肉牽張反射：使用適當?shù)姆瓷溴N來檢查踝反射，同時應在患者坐位、精神放松且足有依靠的情況下進行該檢查。通過叩擊跟腱如果反射出現(xiàn)則視為正常，如在強化措施(如：抓住腳趾來回拉動)下出現(xiàn)則視為強化正常，如在強化措施下仍未出現(xiàn)則視為缺失。MonofilamentTesting:Forthisexamination,itisimportantthatthepatientsfootbesupported(i.e.,allowthesoleofthefoottorestonaflat,warmsurface).Thefil

11、amentshouldinitiallybeprestressed(4-6perpendicularapplicationstothedorsumoftheexaminersfirstfinger).ThefilamentisthenappliedtothedorsumofthegreattoemidwaybetweenthenailfoldandtheDIPjoint.Donotholdthetoedirectly.Thefilamentisappliedperpendicularlyandbriefly,(1second)withanevenpressure.Whenthefilament

12、bends,theforceof10gramshasbeenapplied.Thepatient,whoseeyesareclosed,isaskedtorespondyesifhe/shefeelsthefilament.Eightcorrectresponsesoutof10applicationsisconsiderednormal:onetosevencorrectresponsesindicatesreducedsensationandnocorrectanswerstranslatesintoabsentsensation.單絲檢測：此檢查的重點在于患者的足必須被有效的支撐，同時應

13、休息在平坦和溫暖的支撐物上。開始檢查前應在患者的足背進行4-6次的預加應力。細絲的應用位置在甲褶和第一關節(jié)的中點。在細絲上加以垂直短暫且均勻的力，當細絲彎曲時對肢體產生的壓力為10g?；颊唛]上眼睛開始檢查，10次檢查中患者能感到細絲8次則屬于正常，1-7次感到細絲的存在則屬于減弱，未感覺到細絲的壓力則屬于缺失。PatientVersion患者版本MICHIGANNEUROPATHYSCREENINGINSTRUMENT密歇根神經(jīng)病變篩查表A.History(Tobecompletedbythepersonwithdiabetes)病史(由糖尿病患者親自完成)Pleasetakeafewminu

14、testoanswerthefollowingquestionsaboutthefeelinginyourlegsandfeet.Checkyesornobasedonhowyouusuallyfeel.Thankyou.請回答以下有關你下肢和足感覺的幾個問題，在你日常感覺的基礎上選擇是或不是，非常感謝你的配合。TOC o 1-5 h zAreyoulegsand/orfeetnumb?YesNo你的下肢或足部有麻木感嗎？是否Doyoueverhaveanyburningpaininyourlegsand/orfeet?YesNo你的下肢或足部曾經(jīng)有過灼痛的感覺嗎？Areyourfeettoo

15、sensitivetotouch?YesNo你的雙足有感覺過敏的現(xiàn)象嗎？Doyougetmusclecrampsinyourlegsand/orfeet?YesNo你的下肢或雙足出現(xiàn)過肌肉痛性痙攣的現(xiàn)象嗎？Doyoueverhaveanypricklingfeelingsinyourlegsorfeet?YesNo你的下肢或雙足出現(xiàn)過刺痛的感覺嗎？Doesithurtwhenthebedcoverstouchyourskin?YesNo當被褥接觸皮膚時你有被刺痛的感覺嗎？Whenyougetintothetuborshower,areyouabletotellthehotwaterfromth

16、ecoldwater?當你淋浴時，能清楚的感知水溫的變化？YesNoHaveyoueverhadanopensoreonyourfoot?YesNo你曾經(jīng)有過足部潰瘍嗎？Hasyourdoctorevertoldyouthatyouhavediabeticneuropathy?YesNo你的醫(yī)生診斷過你患有糖尿病神經(jīng)病變嗎？Doyoufeelweakallovermostofthetime?YesNo你大部分時間會感到虛弱無力嗎？Areyoursymptomsworseatnight?YesNo你的癥狀在夜間是否會更嚴重？Doyourlegshurtwhenyouwalk?YesNo你的下肢在

17、走路時受過傷嗎？Areyouabletosenseyourfeetwhenyouwalk?YesNo你行走時能感覺到你的雙足嗎？Istheskinonyourfeetsodrythatitcracksopen?YesNo你足部的皮膚會因為太干燥而裂開嗎？Haveyoueverhadanamputation?YesNo你被進行過截肢手術嗎？Total:總分：MICHIGANNEUROPATHYSCREENINGINSTRUMENT密歇根神經(jīng)病變篩查表B.PhysicalAssessment(Tobecompletedbyhealthprofessional)體格檢查（由醫(yī)療人員填寫）1.Appe

18、aranceofFeet足部外觀檢查Right右a.Normal0Yes1No正常Left左Normal0Yes1No正常Ifno,checkallthatapply:如有異常，檢查下列項目Deformities畸形Dryskin,callus皮膚干燥，有胼胝Infection感染Fissure龜裂Other其他specify:詳細說Deformities畸形Dryskin,callus皮膚干燥，有胼胝Infection感染Fissure龜裂Other其他specify:詳細說b.Ifno,checkallthatapply:如有異常，檢查下列項目2.Ulceration潰瘍0Present正常1Present/ReinforcementAbsent01Present正常Present/Reinforcement強化正常Absent缺失強化正常