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(diào)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(diào)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(chǔ)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(guān)節(jié)半脫位、拇外翻、夏科特關(guān)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(yīng)在大拇趾上檢查，用128Hz音叉放在大拇趾遠(yuǎn)端第一關(guān)節(jié)突起的上方進(jìn)行雙側(cè)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(dāng)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(jìn)行一個試驗來證實受檢者是否誠實反應(yīng)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(dāng)?shù)姆瓷溴N來檢查踝反射，同時應(yīng)在患者坐位、精神放松且足有依靠的情況下進(jìn)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(yīng)

13、休息在平坦和溫暖的支撐物上。開始檢查前應(yīng)在患者的足背進(jìn)行4-6次的預(yù)加應(yīng)力。細(xì)絲的應(yīng)用位置在甲褶和第一關(guān)節(jié)的中點。在細(xì)絲上加以垂直短暫且均勻的力，當(dāng)細(xì)絲彎曲時對肢體產(chǎn)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(xì)絲8次則屬于正常，1-7次感到細(xì)絲的存在則屬于減弱，未感覺到細(xì)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(guān)你下肢和足感覺的幾個問題，在你日常感覺的基礎(chǔ)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(dāng)被褥接觸皮膚時你有被刺痛的感覺嗎？Whenyougetintothetuborshower,areyouabletotellthehotwaterfromth

16、ecoldwater?當(dāng)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(yán)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(jìn)行過截肢手術(shù)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(xì)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(xì)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