密歇根神經(jīng)病變篩查表修訂稿

1、密歇根神經(jīng)病變篩查表How to Use the Michigan Neuropathy Screening Instrument密歇根神經(jīng)病變篩查表使用指南History 病史病史調(diào)查表由病人自己填寫，回答將計(jì)入其篩查總分中，13,56,89,1112,1415題每回答一 個(gè)“是”將加1分，7和13題每回答一個(gè)“否”將加1分，4和10題不計(jì)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。The history questionnaire is self-administered by the patient. Responses are added to obtain the to

2、tal score. Responses ofYes" to items 1-3. 5-6. 8-9. 11-12. 14-15 are each counted as one point. A "no" response on items 7 and 13 counts as 1 point. Item #4 is a measure of impaired circulation and item #10 isa measure of general aesthenia and are not included in scoring. To decrease

3、the potential for bias, all scoring information has been eliminated from the patient version.Physical Assessment體格檢查For all assessments9 the foot should be warm (>30?C).所有評估必須建立在足部溫度>30?C的基礎(chǔ)上Foot Inspection: The feet are inspected for evidence of excessively dry skin, callous formation, fissur

4、es, frank ulceration or deformities. Deiomiilies include flat feet, hammer toes, overlapping toes, halux valgus, joint subluxation, prominent metatan;al heads, medial convexity (Charcot foot) and amputation.足部檢查：足部檢查的項(xiàng)目包括：足部皮膚干燥程度、臍股體、龜裂、潰瘍或畸形?；伟?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。Vibration Sensa

5、tion： Vibration sensation should be performed with the gret toe unsupported. Vibration sensation will be tested bilaterally using a 128 Hz tuning fork placed over the dorsum of the greal toe on the tx>ney prominence of the DIP joint. Patients, whose eyes are closed, will be asked to indicate when

6、 they can no longer sense the vibration from the vibrating tuning fork. In general, the examiner should be able to feel vibration from the hand-held tuning fork for 5 seconds longer on his distal forefinger than a normal subject can at the great toe . examiner'$ DP joint of the first finger vers

7、us patient's toe). If the examiner feels vibration for 1() or nwre seconds on his or her finger, then vibration is considered decreased. A trial should be given when the tuning fork is not vibrating to be certain that the patient is responding to vibration and not pressure or some other clue. Vi

8、bration is scored as I ) present if the examiner senses the vibration on his or her finger for < 10 seconds. 2) reduced if sensed for?10 or 3) absent (no vibration detection.)振動(dòng)覺：振動(dòng)覺應(yīng)在大拇趾上檢查，用128 Hz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(shí)病人閉起眼睛，這時(shí)再詢問患者何時(shí)感覺不到音叉在振動(dòng)了。通常，當(dāng)患者不 能感受到振動(dòng)，而檢查者把音叉放在自己示指上仍能感受到音叉振動(dòng)超過10秒鐘

9、，那么就要考 慮振動(dòng)覺減退了，同時(shí)必須進(jìn)行一個(gè)試驗(yàn)來證實(shí)受檢者是否誠實(shí)反應(yīng)確切的感受而非受暗示， 即使用未振動(dòng)的音叉來檢驗(yàn)。振動(dòng)覺將被記錄為1）正常檢查者感覺音叉振動(dòng)的時(shí)間10秒； 2）減退感覺音叉振動(dòng)的時(shí)間?秒；？）缺失受檢者未察覺振動(dòng)的存在。A lllSCle Stretch Reflexes I The ankle reflexes will be examined using an appropriate reflex hammer . Trommer or Queen square). The ankle reflexes should be elicited in the sitt

10、ing position with the foot dependent and the patient relaxed. For the reflex, the foot should be passively positioned and the foot dorsi-flexcd slightly to obtain optimal stretch of the muscle. The Achilles tendon should be percussed directly. If the reflex is obtained, it is graded as present. If t

11、he reflex is absent, the patient is asked to perform the Jend-rassic maneuver. hooking the fingers together and pulling). Reflexes elicited in曲 the Jendrassic maneuver alone are designated “present with reinforcement.'' If the reflex is absent, even in the face of the Jcndrassic maneuver, (h

12、e reflex is considered absent.肌肉牽弓長反射：使用適當(dāng)?shù)姆瓷溴N來檢查踝反射，同時(shí)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(qiáng)化措施（如：抓住腳趾來回拉動(dòng)）下出 現(xiàn)，則視為強(qiáng)化正常，如在強(qiáng)化措施下仍未出現(xiàn)則視為缺失。Monofilament Testing: For this examination, it is important that the patient's foot be supported . allow the sole of the foot to rest on a flat, war

13、m surface). The filament should initially be prestressed (4-6 perpendicular applications to the dorsum of the examiner's first finger). The filament is then applied to the dorsum of the great toe midway between the nail fold and the DIP joint. Do not hold the toe directly. The filament is applie

14、d perpendicularly and briefly. «1 second) with an even pressure. When the filament bends, the force of 1() grains has been applied. The patienl. whose eyes are closed, is asked to respond yes if he/she feels the filament. Eight correct responses out of 10 applications is considered normal: one

15、to seven correct responses indicates reduced sensation and no correct answers translates into absent sensation.單絲檢雙！I ：此檢查的重點(diǎn)在于患者的足必須被有效的支撐，同時(shí)應(yīng)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46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(diǎn)。在細(xì)絲 上加以垂直短暫且均勻的力，當(dāng)細(xì)絲彎曲時(shí)對肢體產(chǎn)生的壓力為10m患者閉上眼睛開始檢查，10次檢 查中患者能感到細(xì)絲8次則屬于正常，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。Pa

16、tient Version患者版本MICHIGAN NEUROPATHY SCREENING INSTRUMENT密歇根神經(jīng)病變篩查表A. History (To be completed by the person with diabetes)病史(由糖尿病患者親自完成)Please take a few minutes to answer the following questions about the feeling in your legs and feet.Check yes or no based on how you usually feel. Thank you.請回答以下有

17、關(guān)你下肢和足感覺的幾個(gè)問題，在你口常感覺的基礎(chǔ)上選擇是或不是，非常感謝 你的配合01. Are you legs and/or feet numb? ?Yes?No你的下肢或足部有麻木感嗎？?是？否2. Do you ever have any burning pain in your legs and/or feet?Yes?No你的下肢或足部曾經(jīng)有過灼痛的感覺嗎？3. Are your feet too sensitive to touch?Yes?No你的雙足有感覺過敏的現(xiàn)象嗎？4. Do you get muscle cramps in your legs and/or feet?Ye

18、s?No你的下肢或雙足出現(xiàn)過肌肉痛性痙攣的現(xiàn)象嗎？5. Do you ever have any prickling feelings in your legs or feet?Yes?No你的下肢或雙足出現(xiàn)過刺痛的感覺嗎？6. Does it hurt when the bed covers touch your skin?Yes?No當(dāng)被褥接觸皮膚時(shí)你有被刺痛的感覺嗎？7. When you get into the tub or shower, are you able to tell the hot water from the cold water? 當(dāng)你淋浴時(shí)，能清楚的感知水溫的變

19、化？?Yes?No8. Have you ever had an open sore on your foot?Yes?No你曾經(jīng)有過足部潰瘍嗎？9. Has your doctor ever told you that you have diabetic neuropathy?Yes?No你的醫(yī)生診斷過你患有糖尿病神經(jīng)病變嗎？10. Do you feel weak all over most of the time?Yes?No你大部分時(shí)間會(huì)感到虛弱無力嗎？11. Are your symptoms worse at night?Yes?No你的癥狀在夜間是否會(huì)更嚴(yán)重？12. Do you

20、r legs hurt when you walk?Yes?No你的下肢在走路時(shí)受過傷嗎？13. Are you able to sense your feet when you walk?No你行走時(shí)能感覺到你的雙足嗎？14. Is the skin on your feet so dry that it cracks open? ?No你足部的皮膚會(huì)因?yàn)樘稍锒验_嗎？15. Have you ever had an amputation?Yes?No你被進(jìn)行過截肢手術(shù)嗎？Total:總分：a. Normal NoNormal ? 0 Yes ? 1If no, check如有異常，檢DeformitiesDry skin, callus 皮InfectionOtherAbsent 無Present 有Present 有2. Ulceration?0?1?0?1潰瘍Present/Present/Left 左Present Reinforcement Absent Presen