节律性听觉刺激对背侧前运动皮质卒中后偏瘫患者步行功能的疗效分析  

Analysis of the therapeutic effect rhythmic auditory stimulation on walking function in hemiplegic patients with dorsal anterior motor cortex stroke

作　　者：葛亚丽 曹磊[1] 张艳明[1] 孙丽[1] 宋为群[1] Ge Yali;Cao Lei;Zhang Yanming;Sun Li;Song Weiqun(Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院康复医学科,北京100053

出　　处：《中国脑血管病杂志》2023年第8期505-512,共8页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(82272593);北京市医院管理中心2020年度“培育计划”项目(PX2020037)。

摘　　要：目的观察节律性听觉刺激(RAS)对背侧前运动皮质(dPMC)卒中后偏瘫患者步行功能的疗效。方法前瞻性连续纳入2021年1月至2023年1月首都医科大学宣武医院康复医学科收治的病灶包含dPMC的卒中偏瘫患者。按照随机数字表法,将病灶包含dPMC(经头部CT或头部MRI证实)的卒中偏瘫患者随机分为试验组和对照组。两组均接受常规康复治疗(偏瘫肢体综合训练、下肢康复踏车训练),试验组在常规康复治疗的基础上给予RAS。康复治疗时间为30 min/次,2次/d,5 d/周,疗程2周。分别于康复治疗前及完成治疗2周时对两组患者的步态(步速、步幅时间、步频、步长时间差、着地冲击力差)、下肢运动功能[Fugl-Meyer下肢运动功能评定(FMA-LE)量表评分]、步行能力[10 m行走时间测试(10-MWT)]进行比较。结果(1)连续纳入包含dPMC病灶的卒中后偏瘫患者48例,排除严重认知功能障碍者5例,未完成2周康复训练计划者3例,最终纳入40例进行分析,试验组和对照组各20例。两组患者身高、年龄、性别、病灶侧别、病程、卒中类型的差异均无统计学意义(均P>0.05)。(2)试验组治疗前步速、步幅时间、步频、步长时间差、着地冲击力差分别为(0.35±0.03)m/s、(1.70±0.20)s、(66±10)步/min、(0.34±0.04)s、(0.66±0.20)g,对照组治疗前步速、步幅时间、步频、步长时间差、着地冲击力差分别为(0.37±0.03)m/s、(1.57±0.25)s、(67±9)步/min、(0.33±0.03)s、(0.60±0.25)g;试验组治疗2周时步速、步幅时间、步频、步长时间差、着地冲击力差分别为(0.66±0.03)m/s、(2.40±0.25)s、(90±9)步/min、(0.18±0.05)s、(0.35±0.26)g,对照组治疗2周时步速、步幅时间、步频、步长时间差、着地冲击力差分别为(0.54±0.03)m/s、(1.78±0.27)s、(82±11)步/min、(0.22±0.04)s、(0.37±0.21)g。试验组与对照组患者步速、步幅时间、步频、步长时间差、着地冲击力差的时间及组别的总交互�Objective To observe the therapeutic effect of rhythmic auditory stimulation(RAS)on walking function in hemiplegic patients with dorsal anterior motor cortex(dPMC)stroke.Methods From January 2021 to January 2023,stroke hemiplegia patients with a focus containing dPMC who were admitted to the Department of Rehabilitation Medicine,Xuanwu Hospital,Capital Medical University were prospectively included.According to the random number table,stroke hemiplegic patients with lesions containing dPMC(confirmed by head CT or head MRI)were randomly divided into an experimental group and a control group.Both groups of patients were received routine rehabilitation treatment(hemiplegic limb comprehensive training,lower limb rehabilitation treadmill training),while the experimental group were received RAS on the basis of the control group.The rehabilitation treatment time was 30 minutes per session,2 sessions per day,5 days per week,and the course of treatment was 2 weeks.The gait(gait speed,stride time,stride frequency,step length time difference,landing impact difference),lower limb motor function(FuglMeyer lower limb motor function assessment[FMALE]scale score),and walking ability(10 m walking time test[10MWT])of the two groups of patients before and after 2 weeks of rehabilitation treatment were compared.Results(1)All 48 poststroke hemiplegic patients with dPMC lesions were continuously included,5 patients with severe cognitive impairment and 3 patients who did not complete the 2week rehabilitation training plan were excluded,and finally 40 were included for analysis,with 20 cases in the experimental group and 20 cases in the control group.There were no statistically significant differences in height,age,gender,lesion side,disease course,and stroke type between the two groups of patients(all P>0.05).(2)The gait speed,stride time,stride frequency,step length time difference,and landing impact force difference before treatment in the experimental group were(0.35±0.03)m/s,(1.70±020)s,(66±10)step/min,(0.34±0

关 键 词：卒中 节律性听觉刺激 步行障碍 背侧前运动皮质 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R493[医药卫生—临床医学]