成对关联刺激对脑卒中患者上肢运动功能恢复的影响及其与运动皮质兴奋性改变之间的相关性分析  

The effects of paired associative stimulation on motor cortex excitability and the recovery of motor function after stroke

作　　者：随燕芳[1] 宋振华[2] 童良前[2] 杨露[1] 郭铁成[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院康复医学科,武汉430030 [2]中南大学湘雅医学院附属海口医院康复医学科

出　　处：《中华物理医学与康复杂志》2013年第9期703-707,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：国家科学自然基金（81272156）

摘　　要：目的观察成对关联刺激（PAS）对脑卒中患者上肢运动功能恢复的影响，并分析脑卒中患者运动功能恢复与运动皮质兴奋性改变之间的相关性。方法选取脑卒中患者30例，按照随机数字表法将其分为治疗组和对照组，每组15例。对照组采用常规康复治疗，治疗组在此基础上加以频率为0．05Hz、强度为120％静息运动阈值（RMT）、刺激间隔（ISI）为10ms（称为PAS10）、共90对脉冲的PAS干预。治疗前及治疗4周后，采用简式Fugl．Meyer评分（FMA）、Brunnstrom偏瘫运动功能评价标准及改良Barthel指数（MBI）对患者的上肢功能、前臂及手的Brunnstrom分期、ADL能力等作出评价，分析患侧上肢FMA评分差值与健侧半球运动诱发电位（MEP）波幅差值及RMT差值间的相关性。结果治疗前，治疗组患者FMA、前臂及手Brunnstrom分期、MBI评分分别为（15．72±17．70）分、（2．58±1．38）期、（1．40±0．52）期、（48．18±24．42）分；对照组患者上述指标分别为（14．90±16．99）分、（2．83±1．53）期、（1．40±0．55）期、（47．27±21．60）分。治疗前，2组患者FMA、前臂及手Brunnstrom分期、MBI评分间比较，差异无统计学意义（P〉0．05）。治疗4周后，治疗组患者FMA、前臂及手Brunnstrom分期、MBI评分分别为（26．63±19．19）分、（3．25±1．70）期、（1．56±0．53）期、（63．63±25．74）分，对照组患者上述指标分别为（17．54±18．24）分、（3．42±1．44）期、（1．50±0．52）期、（55．45±19．29）分，与组内治疗前比较均有所改善（P〈0．05），与对照组比较，治疗组治疗4周后各指标均有改善趋势，但差异无统计学意义（P〉0．05）。治疗前，治疗组MEP波幅、潜伏期及RMT分别为[（1．29±0．66）mV]、[（20．79±1．48）ms]、[（42．75±9．91）％]，对照组MEP波幅、潜伏期及RMT分别为[（1．54±0．93）mV]、[（21�Objective To investigate the effects of paired associative stimulation （PAS） on the recovery of upper limb motor function in stroke patients, and to analyze the relationship between the change of motor cortex excitability in the eontralesional hemisphere and the recovery of motor function in the affected upper limb. Methods Thirty hemiplegic stroke patients were divided randomly into a treatment group and a control group. Both groups were given routine rehabilitation therapy, but the treatment group also received PAS consisting of transcranial magnetic stimulation （TMS） of the intact motor cortex and electrical stimulation （ES） of the median nerve at the wrist of the intact arm with an interval of 10 ms between the TMS and ES （PAS10）. The PAS10 was delivered at a frequency of 0.05 Hz and an intensity of 120% the resting motor threshold （RMT） , once daily for 30 minutes, five times a week for 4 weeks. Corticospinal excitability was measured using motor evoked potentials （MEP） and the RMT. The Fugl- Meyer upper limb assessment （FMA） , Brunnstrom staging and the modified Barthel index （MBI） were also applied before and at the end of the 4 weeks of treatment. Correlation was sought between any changes in MEP amplitude, the RMT of the contralesional hemisphere and changes in the FMA results. Results Before the intervention there were no significant differences between the two groups in terms of any of the assessments. After 4 weeks of treatment, all the assessments had changed significantly compared to those before the treatment, but there were still no significant differences between the two groups in terms of any the assessments. After 4 weeks of treatment, the differences in MEP amplitude from the contralesional hemisphere and the differences in FMA scores were positively and significantly correlated with a correlation coefficient of r = 0. 431. The lesioned hemisphere was also positively correlated with the differences in FMA scores with a significant correlation coefficient of r =

关 键 词：脑卒中 经颅磁刺激 成对关联刺激 运动功能 运动皮质兴奋性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]