经颅直流电刺激同步多通道功能性电刺激对脑卒中偏瘫患者下肢运动功能影响的对照研究  

Effects of tDCS synchronized FES on lower limb motor function of stroke patients with hemiplegia:a randomized controlled study

作　　者：陈汉波 郑修元[2] 吕晓 丁丽娟 贺灵慧 刘晨 郑文华 郭永亮 燕铁斌[2,4] CHEN Hanbo;ZHENG Xiuyuan;LV Xiao(Dept,of Rehabilitation,Guangdong 999 Brain Hospital,510510)

机构地区：[1]广东三九脑科医院康复治疗科,广州市510510 [2]中山大学孙逸仙纪念医院康复医学科 [3]广东三九脑科医院康复医学科 [4]广东省康复与养老工程技术研究中心

出　　处：《中国康复医学杂志》2021年第10期1227-1232,共6页Chinese Journal of Rehabilitation Medicine

基　　金：国家自然科学基金(81772447);国家自然科学基金青年项目(81902290);广东省医学科研基金(A2018172);广东省医学科研基金(A2021407);广州市科技局产学研协同创新重大专项(201704020140);逸仙临床研究培育项目(SYS-Q-201803)。

摘　　要：目的:观察经颅直流电刺激(transcranial direct current stimulation,t DCS)同步基于正常行走模式的下肢多通道功能性电刺激(functional electrical stimulation,FES)对脑卒中偏瘫恢复期患者下肢运动功能的影响。方法:66例符合入组条件的脑卒中偏瘫患者,分层后随机分成3组:t DCS组(n=22)、FES组(n=22)、同步组(n=22)。t DCS组给予头部t DCS治疗同步下肢安慰FES治疗;FES组给予头部安慰t DCS治疗同步下肢FES治疗;同步组给予头部t DCS治疗同步下肢FES治疗。治疗20min/次、1次/d、连续治疗12d。在治疗前(T0)、治疗6次(T1)及治疗12次(T2)后分别采用下列量表评估:脑卒中患者姿势评分(PASS)、Fugl-Meyer下肢运动功能评定(FMA-L)、Berg平衡量表(BBS)、计时"起立-行走"测试(TUGT)、改良Barthel指数(MBI)。结果:治疗前3组患者各评定结果之间的差异无显著性。治疗12次后,三组患者的BBS、TUGT、MBI(下肢)及FES组和同步组的PASS较治疗前差异有显著性(P<0.05)。变化率比较,治疗12次后三组患者FMA-L、BBS、TUGT、MBI(下肢)及FES组和同步组的PASS的变化率,较治疗6次时变化率差异均有显著性。t DCS组与FES组比较,MBI(下肢)差异有显著性(P<0.05);同步组与t DCS组比较,PASS、MBI(下肢)差异有显著性(P<0.05);同步组与FES组比较BBS变化率差异有显著性(P<0.05)。其余变化差异无显著性。结论:三种方法均可有效改善脑卒中后恢复期偏瘫患者的下肢功能,t DCS同步FES的治疗在部分评估指标方面的疗效优于单用t DCS或单用FES治疗。Objective:To observe the effect of transcranial direct current stimulation(tDCS) synchronized multi-channel functional electrical stimulation(FES) based on normal walking pattern on lower limb motor function in patients with post-stroke hemiplegia.Method:A total of 66 patients with stroke and hemiplegia were randomly divided into t DCS group(n=22),FES group(n=22), and synchronous group(n=22) after stratification. The t DCS group was given head t DCS treatment and lower extremity sham FES treatment,the FES group was given head sham t DCS treatment and lower extremity FES treatment,and the synchronous group was given head t DCS treatment and lower extremity FES treatment. The treatment was 20 min/time, 1 time/d, for 12 days. Before treatment(T0),6 times(T1)and 12 times(T2), the following scales were used to evaluate:posture assessment of stroke scale(PASS),Fugl-Meyer Assessment of Lower Extremity(FMA-L), Berg balance scale(BBS), timed "up&go" test(TUGT),modified Barthel index(MBI).Result:There was no significant difference between the evaluation results of the 3 groups before treatment. After treatments for 12 times,the BBS,TUGT,MBI(lower limbs) of the 3 groups and the PASS of the FES group and the synchronization group were significantly different compared with that before treatment(P<0.05).And after treatments for 12 times,the rate of change of FMA-L,BBS,TUGT,MBI(lower limbs) of the 3 groups and the rate of change of PASS of the FES group and the synchronization group were significantly different with that after treatments for 6 times. Comparing the t DCS group with the FES group,the difference in MBI(lower limbs) was significant(P<0.05);comparing the synchronization group with the t DCS group,the difference in PASS and MBI(lower limbs) was significant(P<0.05);There was a significant difference in the BBS change rate between the synchronization group and the FES group(P<0.05). There was no significant difference in other indicators(P>0.05).Conclusion:Three methods can effectively improve the lower limb function o

关 键 词：经颅直流电刺激 功能性电刺激 同步 脑卒中 下肢功能 

分 类 号：R493[医药卫生—康复医学] R743.3[医药卫生—临床医学]