摘要
目的:观察脑梗死偏瘫患者进行神经肌肉电刺激时大脑中动脉的血流变化与其上肢运动功能恢复的相关性。方法:以2003-12/2004-12东莞市人民医院收治住院的脑梗死偏瘫患者76例为观察对象,所有患者均为首次单侧发病,脑梗死病程30d以上,病情稳定。所有患者进行为期12周的神经肌肉电刺激,频率25～40Hz,双向方波,强度以患侧上肢出现明显肌肉收缩为准,选择曲池、上廉、肘、手三里、手五里等部位,推拿加按摩模式,每种模式各15min,30min/次,1次/d,每周治疗5次,并进行促通技术治疗。治疗前和治疗后6周及12周用Fugl-Meyer运动功能量表的上肢评定部分(33项,每项2分,满分66分)对患侧上肢进行运动功能评定。根据12周时Fugl-Meyer上肢功能评分分为恢复不良组(<20.6分)和恢复良好组(≥20.6分)。每周用经颅多普勒测定平卧休息时和肘关节电刺激治疗时双侧大脑中动脉血流速度1次,计算肘关节电刺激治疗后大脑中动脉血流速度增加百分率,计算出均值,进行两组间的比较,并对12周时上肢的Fugl-Meyer评分与脑中动脉血流速度增加百分率间的相关性进行分析。结果:按意向处理分析,76例患者均进入结果分析。①肘关节电刺激后大脑中动脉血流速度增加百分率:刺激健侧时两组都表现为健侧高于患侧(P<0.05);而刺激患侧时,两组都表现为双侧增高,且恢复良好组健侧明显高于恢复不良组犤(10.24±1.57)%,(7.54±1.34)%,P<0.05犦。②平卧休息时两侧大脑中动脉血流速度:恢复良好组与恢复不良组无差异(P>0.05)。③Fugl-Meyer上肢评分:治疗12周后恢复良好组(n=40)和恢复不良组(n=36)均较治疗前显著提高(21.26±8.12,10.86±3.63;16.36±2.75,9.76±4.22;P<0.05),恢复良好组功能明显好于恢复不良组(P<0.05)。④相关性检验结果:治疗12周上肢的Fugl-Meyer评分与电刺激患侧肘关节时双侧大脑中动脉血流速度增加百分率均呈明显的正相关(r患侧=0.788;r健侧=0.938,P<0.05)。结论:脑卒中偏瘫患者神经肌肉电刺激治疗后,瘫痪肢体功能恢复程度与电刺激治疗(尤其是刺激患侧)时双侧大脑中动脉血流速度密切相关,血流速度增加越明显者,治疗后Fugl-Meyer评分越高,肢动功能恢复的效果也越好。
AIM： To observe the correlation of blood flow changes and upper limb movement functional restoration of middle cerebral artery in the treatment of electric stimulation on nerve muscle in patients with cerebral infarction hemiplegy. METHODS： Seventy-six patients with cerebral infarction hemiplegy, who were treated in Dongguan People＇s Hospital, were selected to observe from December 2003 to December 2004. All patients were onset of illness on single side with over 30 days course of cerebral infarction and patient＇s condition was stable. Electric stimulation of nerve muscle was treated on all patients for 12 weeks with 25-40Hz frequency and diplo-direction square wave, and the intensity followed the standard of the appearance of obvious muscle contraction on the epipodite in the ill side. Manipulation and massage type were used on the place of Ch＇uch＇ih （LI 11）, Shanglien（LI 9）, Chouliao （LI 12）, Shousanli （LI 10） and Shouwuli （LI 13） etc. with 15 minutes in every model and 30 minutes once and once per day with five times per week. At the 6^th and 12^th week before and after treatment motor function test on the epipodite in the ill side was conducted with epipodite test part of Fugl-Meyer motor function scale test （including 33 terms, 2 points in every term, and full mark was 66 points）. According to the 12^th week Fugl-Meyer motor function scale test they were assigned into malrecovery group （〈 20.6 points）and well recovery group （≥ 20.6 points）. Blood flow-rate of middle artery in double side brain when lay low and electric stimulation treatment of elbow joint with transcranial Doppler （TCD） once every week. The increase percentage of blood flow-rate of artery in middle brain after electric stimulation treatment was calculated, including average value, and the comparison in the two groups was done. The correlation between the 12^th week Fugl-Meyer test and the increase percentage of blood flow-rate of artery in middle brain was analyzed. RESULTS： According to intention-to-treat analysis, 76 patients were all involved in the analysis of results. ① The increase percentage of blood flow-rate of artery in middle brain after electric stimulation in elbow joint： It was higher in uninjured side than that in injured side when uninjured side was stimulated （P 〈 0.05）; It increased in double side in the two groups when injured side was stimulated, besides, it was significantly higher in well recovery group in uninjured side than that in mal-recovery group [ （ 10.24±1.57 ）, （7.54±1.34） %, （P 〈 0.05）]. ② Blood flow-rate of middle cerebral artery in double side when lay low： There was insignificant difference in well recovery group and mal-recovery group （P 〉 0.05 ）. ③ Fugl-Meyer epipodite test： After 12 weeks treatment it was significantly higher in well recovery group and in mal-recovery group （n=36）than that before treatment （21.26±8.12,10.86±3.63 ; 16.36±2.75,9.76±4.22;P 〈 0.05 ）, and the function in well recovery group was significantly better than that in mal-recovery group （P〈 0.05）. ④ The correlation check result： The epipodite Fugl-Meyer test after 12 weeks treatment and blood flow-rate of middle cerebral artery in double side when injured side of elbow joint was treated with electric stimulation showed significantly positive correlation （rinjured side=0.788;runinjured side=0.938, P 〈 0.05）. CONCLUSION： After electric stimulation on nerve muscle in patients with stroke hemiplegy, functional restoration degree of paralysis limb has close relation with blood flow-rate of middle cerebral artery on the treatment of electric stimulation （especially the stimulation of injured side）. The more significant the increase of blood flow-rate, the higher the Fugl-Meyer score after treatment, and the effect of limb functional restoration will also be better.
出处
《中国临床康复》
CSCD
北大核心
2005年第25期8-10,共3页
Chinese Journal of Clinical Rehabilitation
