摘要
目的 探讨反复促通疗法联合神经肌肉电刺激在脑卒中后单侧上肢功能障碍患者康复中的应用效果。方法 选取2021年1月—2024年1月武进中医医院收治的脑卒中后单侧上肢功能障碍患者98例为研究对象,按照随机数字表法将其分为神经肌肉电刺激组和反复促通疗法联合组,各49例,其中神经肌肉电刺激组中有1例患者因失访脱落,最终神经肌肉电刺激组48例和反复促通疗法联合组49例纳入统计分析。神经肌肉电刺激组患者接受神经肌肉电刺激,反复促通疗法联合组患者接受反复促通疗法联合神经肌肉电刺激,均连续治疗4周。比较两组临床疗效,治疗前后上肢运动和动作能力[采用Fugl-Meyer运动功能评估量表上肢部分(FMA-UE)、上肢动作研究量表(ARAT)评估]、血清同型半胱氨酸(Hcy)、血清血管紧张素转换酶(ACE)、日常生活活动能力[采用改良Barthel指数(mBI)评估]、神经功能损伤程度[采用美国国立卫生研究院卒中量表(NIHSS)评估],不良反应发生率。结果反复促通疗法联合组治疗总有效率高于神经肌肉电刺激组(P<0.05)。治疗后,两组FMA-UE、ARAT评分分别高于本组治疗前,且反复促通疗法联合组FMA-UE、ARAT评分高于神经肌肉电刺激组(P<0.05)。治疗后,两组Hcy、ACE分别低于本组治疗前,且反复促通疗法联合组Hcy、ACE低于神经肌肉电刺激组(P<0.05)。治疗后,两组mBI评分分别高于本组治疗前,NIHSS评分分别低于本组治疗前,且反复促通疗法联合组mBI评分高于神经肌肉电刺激组,NIHSS评分低于神经肌肉电刺激组(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论反复促通疗法联合神经肌肉电刺激可提高脑卒中后单侧上肢功能障碍患者的临床疗效,改善患者的上肢运动和动作能力,降低Hcy、ACE水平,提高患者日常生活活动能力,减轻神经功能损伤程度,同时不会增加不良反应。
Objective To investigate the application effect of repeated facilitation therapy combined with neuromuscular electrical stimulation in the rehabilitation of patients with unilateral upper limb dysfunction after stroke.Methods A total of 98 patients with unilateral upper limb dysfunction after stroke admitted to Wujin Hospital of Traditional Chinese Medicine from January 2021 to January 2024 were selected as the research subjects.The patients were divided into neuromuscular electrical stimulation group and repeated facilitation therapy combination group by random number table method,with 49 cases in each group.One patient in the neuromuscular electrical stimulation group dropped out due to loss to follow-up.Finally,48patients in the neuromuscular electrical stimulation group and 49 patients in the repeated facilitation therapy combination group were included in the statistical analysis.The patients in the neuromuscular electrical stimulation group received neuromuscular electrical stimulation,while the patients in the repeated facilitation therapy combination group received repeated facilitation therapy combined with neuromuscular electrical stimulation.The clinical effect after treatment,upper limb movement and motor ability[evaluated by Fugl-Meyer Motor Assessment of Upper Extremity(FMA-UE),Action Research Arm Test(ARAT)],serum homocysteine(Hcy),serum angiotensin converting enzyme(ACE),activities of daily living[evaluated by modified Barthel Index(mBI)],degree of neurological impairment[evaluated by National Institute of Health Stroke Scale(NIHSS)]before and after treatment,and incidence of adverse reactions were compared between the two groups.Results The total effective rate of repeated facilitation therapy combination group was higher than that of neuromuscular electrical stimulation group(P<0.05).After treatment,the FMA-UE,ARAT scores in two groups were higher than those before treatment,respectively,and the FMA-UE,ARAT scores in repeated facilitation therapy combination group were higher than those in neuromuscular electrical stimulation group(P<0.05).After treatment,the Hcy,ACE in two groups were lower than those before treatment,respectively,and the Hcy,ACE in repeated facilitation therapy combination group were lower than those in neuromuscular electrical stimulation group(P<0.05).After treatment,the mBI score in two groups was higher than that before treatment,respectively,the NIHSS score in two groups was lower than that before treatment,respectively,and the mBI score in repeated facilitation therapy combination group was higher than that in neuromuscular electrical stimulation group,NIHSS score in repeated facilitation therapy combination group was lower than that in neuromuscular electrical stimulation group(P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Repeated facilitation therapy combined with neuromuscular electrical stimulation can improve the clinical efficacy of patients with unilateral upper limb dysfunction after stroke,improve the upper limb movement and motor ability,,reduce Hcy and ACE levels,enhance activities of daily living,reduce the degree of neurological impairment,and do not increase adverse reactions.
作者
张白慧
蒋娟愉
王伟锋
ZHANG Baihui;JIANG Juanyu;WANG Weifeng(Department of Rehabilitation,Wujin Hospital of Traditional Chinese Medicine,Changzhou 213000,China)
出处
《实用心脑肺血管病杂志》
2025年第4期75-80,共6页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
江苏省自然科学基金面上项目(BK20211088)。
关键词
卒中
偏瘫
康复
上肢功能障碍
反复促通疗法
神经肌肉电刺激
Stroke
Hemiplegia
Rehabilitation
Upper limb dysfunction
Repeated facilitation therapy
Neuromuscular electrical stimulation
