反馈式功能性电刺激治疗对脑梗死患者上肢运动功能恢复的影响及其机制的fMRI研究  

Curative effect of feedback functional electrical stimulation treatment on upper limb movement functions in patients with stroke and its mechanism： a fMRI study

作　　者：邢亮[1] 张通[1] 顾越[2] 张亚菲[1] 张锋[3] 刘丽旭[1] 

机构地区：[1]首都医科大学康复医学院,中国康复研究中心北京博爱医院神经康复中心科,北京100068 [2]首都医科大学康复医学院OT科,北京100068 [3]北京大学第一医院麻醉科,北京100034

出　　处：《中华神经医学杂志》2013年第6期604-608,共5页Chinese Journal of Neuromedicine

基　　金：国家“十二五”科技支撑计划项目课题（2011BA108811）;财政部课题（中央级公益性科研院所基本科研业务费专项资金项目）（CZ2011-161

摘　　要：目的探讨反馈式功能性电刺激治疗对脑梗死患者上肢运动功能恢复的影响以及应用功能核磁共振成像（fMRI）分析其作用机制。方法将自2011年8月至2012年12月在中国康复研究中心神经康复中心住院的脑梗死患者21例（一侧肢体瘫痪且偏瘫侧肢体腕背屈关节活动度大于15。及肌张力为改良AshworthI级及以下的可完成部分主动运动的患者）按随机数字表法分为反馈式功能性电刺激组8例、单纯功能性电刺激组7例及常规康复治疗组6例。3组患者均进行常规神经内科药物治疗和康复治疗，其中反馈式功能性电刺激组进行反馈式功能性电刺激治疗，单纯功能性电刺激组行功能性电刺激治疗，疗程4周。分别在治疗前及治疗4周后次日进行Fugl．Meyer运动功能量表上肢部分项目及腕背伸角度评估，以及3d内应用fMRI进行脑M1区激活强度检查。结果（1）治疗后4周时，3组患者的Fugl—Meyer运动功能量表上肢部分项目评分及腕背伸角度较治疗前均有改善，其中反馈式功能性电刺激组、单纯功能性电刺激组差异均有统计学意义（氏0．05）；反馈式功能性电刺激组亦明显优于单纯功能性电刺激组，差异有统计学意义（P〈0．05）。（2）治疗后4周时，3组患者的患侧脑M1区激活强度较治疗前均有改善，其中反馈式功能性电刺激组差异有统计学意义（P〈0．05）：反馈式功能性电刺激组亦明显优于单纯功能性电刺激组，差异有统计学意义（P〈0．05）。结论单纯功能性电刺激和反馈式功能性电刺激均有利于脑梗死后上肢运动功能的提高，并有助于脑功能的重组，且后者较前者疗效更佳。Objective To explore the effect of feedback functional electrical stimulation （BFES） treatment on upper limb movement functions in patients with stroke and analyze its mechanism with functional magnetic resonance imaging （fMRI）. Methods Twenty-one inpatients with stroke were chose in our study fxom 2011 August to 2012 December. They were hemiplegy, and their wrist dorsiflexion ranges of motion of hemiplegic limbs were greater than 15 degrees; their muscular tension was equal or less than modified Ashworth I＋, and they could complete some active movements. The patients were randomly divided into BFES treatment group （n=8）, functional electrical stimulation treatment （FES） group（n-7） and conventional rehabilitation group （n=6）. Three groups of patients were given routine drug treatment and rehabilitation treatment. They were assessed with Fugl-Meyer scale （upper limbs）, wrist flexion and M1 of fMRI before treatment and 4 weeks after treatment. ResultsThe scores of Fugl-Meyer （upper limbs） and wrist extension improved after treatment , BFES group enjoyed more obvious effect than the other groups （P〈0.05）; 4 weeks after treatment, the three groups of patients affected brain areas activated M1 area strength improved more significantly as compared with those before treatment, where BFES treatment group showed statistically difference （P〈 0.05）. Conclusion Both FES and BFES treatment can improve the motor recovery of upper limbs after stroke and they can contribute to brain functional reorganization, BFES, as compared with FES, is more effective.

关 键 词：脑梗死 反馈式功能性电刺激 功能核磁共振成像 上肢运动功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]