密歇根神经病变筛查表

HowtoUsetheMichiganNeuropathyScreeningInstrument密歇根神经病变筛查表使用指南History病史Thehistoryquestionnaireisself-administeredbythepatient.Responsesareaddedtoobtainthetotalscore.Responsesof“yes”toitems1-3,5-6,8-9,11-12,14-15areeachcountedasonepoint.A“no”responseonitems7and13countsas1point.Item#4isameasureofimpairedcirculationanditem#10isameasureofgeneralaestheniaandarenotincludedinscoring.Todecreasethepotentialforbias,allscoringinformationhasbeeneliminatedfromthepatientversion.病史调查表由病人自己填写，回答将计入其筛查总分中，1-3,5-6,8-9,11-12,14-15题每回答一个“是”将加1分，7和13题每回答一个“否”将加1分，4和10题不计分。为了减少潜在的误差，在病史调查表上将不出现得分信息。PhysicalAssessment体格检查Forallassessments,thefootshouldbewarm(30C).所有评估必须建立在足部温度30C的基础上FootInspection:Thefeetareinspectedforevidenceofexcessivelydryskin,callousformation,fissures,frankulcerationordeformities.Deformitiesincludeflatfeet,hammertoes,overlappingtoes,haluxvalgus,jointsubluxation,prominentmetatarsalheads,medialconvexity(Charcotfoot)andamputation.足部检查：足部检查的项目包括：足部皮肤干燥程度、胼胝体、龟裂、溃疡或畸形。畸形包括：扁平足、锤状趾、重叠趾、足外翻、关节半脱位、拇外翻、夏科特关节和截肢。VibrationSensation:Vibrationsensationshouldbeperformedwiththegreattoeunsupported.Vibrationsensationwillbetestedbilaterallyusinga128HztuningforkplacedoverthedorsumofthegreattoeontheboneyprominenceoftheDIPjoint.Patients,whoseeyesareclosed,willbeaskedtoindicatewhentheycannolongersensethevibrationfromthevibratingtuningfork.Ingeneral,theexaminershouldbeabletofeelvibrationfromthehand-heldtuningforkfor5secondslongeronhisdistalforefingerthananormalsubjectcanatthegreattoe(e.g.examiner’sDIPjointofthefirstfingerversuspatient’stoe).Iftheexaminerfeelsvibrationfor10ormoresecondsonhisorherfinger,thenvibrationisconsidereddecreased.Atrialshouldbegivenwhenthetuningforkisnotvibratingtobecertainthatthepatientisrespondingtovibrationandnotpressureorsomeotherclue.Vibrationisscoredas1)presentiftheexaminersensesthevibrationonhisorherfingerfor10seconds,2)reducedifsensedfor10or3)absent(novibrationdetection.)振动觉：振动觉应在大拇趾上检查，用128Hz音叉放在大拇趾远端第一关节突起的上方进行双侧检查，同时病人闭起眼睛，这时再询问患者何时感觉不到音叉在振动了。通常，当患者不能感受到振动，而检查者把音叉放在自己示指上仍能感受到音叉振动超过10秒钟，那么就要考虑振动觉减退了，同时必须进行一个试验来证实受检者是否诚实反应确切的感受而非受暗示，即使用未振动的音叉来检验。振动觉将被记录为1）正常检查者感觉音叉振动的时间10秒；2）减退感觉音叉振动的时间秒；）缺失受检者未察觉振动的存在。MuscleStretchReflexes:Theanklereflexeswillbeexaminedusinganappropriatereflexhammer(e.g.TrommerorQueensquare).Theanklereflexesshouldbeelicitedinthesittingpositionwiththefootdependentandthepatientrelaxed.Forthereflex,thefootshouldbepassivelypositionedandthefootdorsi-flexedslightlytoobtainoptimalstretchofthemuscle.TheAchillestendonshouldbepercusseddirectly.Ifthereflexisobtained,itisgradedaspresent.Ifthereflexisabsent,thepatientisaskedtoperformtheJend-rassicmaneuver(i.e.,hookingthefingerstogetherandpulling).ReflexeselicitedwiththeJendrassicmaneuveralonearedesignated“presentwithreinforcement.”Ifthereflexisabsent,eveninthefaceoftheJendrassicmaneuver,thereflexisconsideredabsent.肌肉牵张反射：使用适当的反射锤来检查踝反射，同时应在患者坐位、精神放松且足有依靠的情况下进行该检查。通过叩击跟腱如果反射出现则视为正常，如在强化措施(如：抓住脚趾来回拉动)下出现，则视为强化正常，如在强化措施下仍未出现则视为缺失。MonofilamentTesting:Forthisexamination,itisimportantthatthepatient’sfootbesupported(i.e.,allowthesoleofthefoottorestonaflat,warmsurface).Thefilamentshouldinitiallybeprestressed(4-6perpendicularapplicationstothedorsumoftheexaminer’sfirstfinger).ThefilamentisthenappliedtothedorsumofthegreattoemidwaybetweenthenailfoldandtheDIPjoint.Donotholdthetoedirectly.Thefilamentisappliedperpendicularlyandbriefly,(1second)withanevenpressure.Whenthefilamentbends,theforceof10gramshasbeenapplied.Thepatient,whoseeyesareclosed,isaskedtorespondyesifhe/shefeelsthefilament.Eightcorrectresponsesoutof10applicationsisconsiderednormal:onetosevencorrectresponsesindicatesreducedsensationandnocorrectanswerstranslatesintoabsentsensation.单丝检测：此检查的重点在于患者的足必须被有效的支撑，同时应休息在平坦和温暖的支撑物上。开始检查前应在患者的足背进行4-6次的预加应力。细丝的应用位置在甲褶和第一关节的中点。在细丝上加以垂直短暂且均匀的力，当细丝弯曲时对肢体产生的压力为10g。患者闭上眼睛开始检查，10次检查中患者能感到细丝8次则属于正常，1-7次感到细丝的存在则属于减弱，未感觉到细丝的压力则属于缺失。PatientVersion患者版本MICHIGANNEUROPATHYSCREENINGINSTRUMENT密歇根神经病变筛查表A.History(Tobecompletedbythepersonwithdiabetes)病史（由糖尿病患者亲自完成）Pleasetakeafewminutestoanswerthefollowingquestionsaboutthefeelinginyourlegsandfeet.Checkyesornobasedonhowyouusuallyfeel.Thankyou.请回答以下有关你下肢和足感觉的几个问题，在你日常感觉的基础上选择是或不是，非常感谢你的配合。1.Areyoulegsand/orfeetnumb?YesNo你的下肢或足部有麻木感吗？是否2.Doyoueverhaveanyburningpaininyourlegsand/orfeet?YesNo你的下肢或足部曾经有过灼痛的感觉吗？3.Areyourfeettoosensitivetotouch?YesNo你的双足有感觉过敏的现象吗？4.Doyougetmusclecrampsinyourlegsand/orfeet?YesNo你的下肢或双足出现过肌肉痛性痉挛的现象吗？5.Doyoueverhaveanypricklingfeelingsinyourlegsorfeet?YesNo你的下肢或双足出现过刺痛的感觉吗？6.Doesithurtwhenthebedcoverstouchyourskin?YesNo当被褥接触皮肤时你有被刺痛的感觉吗？7.Whenyougetintothetuborshower,areyouabletotellthehotwaterfromthecoldwater?当你淋浴时，能清楚的感知水温的变化？YesNo8.Haveyoueverhadanopensoreonyourfoot?YesNo你曾经有过足部溃疡吗？9.Hasyourdoctorevertoldyouthatyouhavediabeticneuropathy?YesNo你的医生诊断过你患有糖尿病神经病变吗？10.Doyoufeelweakallovermostofthetime?YesNo你大部分时间会感到虚弱无力吗？11.Areyoursymptomsworseatnight?YesNo你的症状在夜间是否会更严重？12.Doyourlegshurtwhenyouwalk?YesNo你的下肢在走路时受过伤吗？13.Areyouabletosenseyourfeetwhenyouwalk?YesNo你行走时能