低频脉冲电刺激对脑卒中患者静息态脑功能网络连接的影响  

The effects of low frequency electrical stimulation on connectivity changes in the brain and motor function after ischemic stroke

作　　者：刘定华[1] 刘冬柏[1] 洪珊珊[1] 韩伯军[1] 江岐涛[1] 张剑宇[1] 彭岚[1] 孟宪平[1] 

机构地区：[1]东南大学医学院附属江阴医院,无锡214400

出　　处：《中华物理医学与康复杂志》2012年第11期821-824,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：国家自然科学基金项目（61004102）,无锡市科技计划项目（CSZ00968）

摘　　要：目的应用静息态功能磁共振成像（rs-fMRI）观察急性缺血性脑卒中患者经低频脉冲电刺激治疗前、后其脑功能网络连接变化。方法共选取45例急性缺血性脑卒中患者，采用随机数字表法将其分为观察组及对照组。2组患者均给予常规内科处理及对症治疗，观察组在此基础上辅以低频脉冲电刺激。于治疗前、治疗2周后采用神经功能缺损评分（CNS）、美国国立卫生研究院卒中量表（NIHSS）、简式Fugl-Meyer运动功能评分（FMA）及改良Barthel指数（MBI）对2组患者进行评定；采用rs-fMRI检测2组患者治疗前、后双侧大脑运动皮质功能连接差异，同时分析运动皮质功能连接与神经功能缺损、肢体运动功能及日常生活活动能力间的相关性。结果治疗后2组患者CNS、NIHSS、FMA及MBI评分均显著改善（P〈0．05），并且以观察组FMA及MBI评分的改善幅度较显著，与对照组间差异具有统计学意义（P〈0．05）。2组患者治疗后其双侧大脑运动皮质功能连接系数均显著下降（P〈0．05）；通过相关性分析发现，观察组运动皮质功能连接系数的下降幅度与FMA评分改善值间具有显著相关性（P〈0．05）。结论低频脉冲电刺激能进一步促进缺血性脑卒中患者肢体运动功能及日常生活活动能力改善；随着患者功能恢复，其大脑运动皮质功能连接系数较治疗前显著降低，且该连通性改变与肢体运动功能改善间具有显著相关性。Objective To investigate any changes in motor functional connectivity in the brains of acute ische- mic stroke patients after low frequency electrical stimulation. Methods Twenty-five ischemic stroke patients were given low frequency electrical stimulation in addition to their conventional rehabilitation treatment. Another 20 patients received only conventional treatment as a control group. Resting-state functional magnetic resonance imaging （rs-fMRI） was employed to assess motor function connectivity in the brains of all 45 subjects before and after treatment. Any differences in functional impairment, extremity motor function or ability in the activities of daily living were also recor- ded before and after treatment. Results In both groups, average scores on the Canadian neurological scale （CNS） and the National Institutes of Health stroke scale （NIHSS） had been reduced significantly after treatment and Fugl- Meyer assessment （FMA） and modified Barthel index （MBI） scores had significantly increased. The average improve- ments in terms of FMA and MBI scores were significantly greater in the observation group. Compared with before treat- ment, the coefficient of functional connectivity of the bilateral motor cortex had decreased significantly after treatment in both groups. In the observation group the changes were significantly correlated with the improvements in FMA scores. Conclusion Neural functional impairment after ischemic stroke can be reduced significantly and extremity motor func- tion and ability in the activities of daily living can be significantly improved by low frequency electrical stimulation.

关 键 词：急性缺血性脑卒中 功能磁共振成像 运动皮质 

分 类 号：R743.3[医药卫生—神经病学与精神病学]