对侧控制神经肌肉电刺激对脑卒中偏瘫患者脑功能连接的影响  

Effect of Contralaterally Controlled Neuromuscular Electrical Stimulation on Brain Function Connectivity of Patients with Hemiplegia after Stroke

作　　者：朱兰[1,2] 眭有昕 王庆雷 徐胜 沈滢 郭川[1,2] ZHU Lan;SUI Youxin;WANG Qinglei;XU Sheng;SHEN Ying;GUO Chuan(The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China;The School of Rehabilitation Medicine,Nanjing Medical University,Nanjing,Jiangsu 210029,China;Changzhou De'an Hospital,Changzhou,Jiangsu 213004,China)

机构地区：[1]南京医科大学第一附属医院,江苏南京210029 [2]南京医科大学康复医学院,江苏南京210029 [3]常州市德安医院,江苏常州213004

出　　处：《康复学报》2023年第6期502-507,514,共7页Rehabilitation Medicine

基　　金：国家重点研发计划项目(2022YFC2009700);国家自然科学基金青年项目(82302882)。

摘　　要：目的:应用功能性近红外光谱成像技术(fNIRS)分析对侧控制神经肌肉电刺激(CCNMES)对脑卒中偏瘫患者脑功能连接变化的影响。方法:选择2021年7月—2022年1月在常州市德安医院康复医学中心就诊的脑卒中上肢偏瘫患者48例,采用计算机生成的随机化列表按1∶1分为对照组和观察组,每组24例。对照组接受神经肌肉电刺激(NMES)治疗,患侧前臂伸肌侧放置2个刺激电极以产生腕部伸展,刺激强度以可以产生最大程度的腕部伸展,但不引起患者不适为度,矩形脉冲60 Hz,脉冲宽度200μs,刺激周期为开15 s、关10 s。观察组接受CCNMES治疗,在健侧前臂伸肌侧放置2个表面电极和1个参考电极,在患侧前臂伸肌侧放置2个刺激电极以产生腕部伸展,患侧刺激强度以患侧手腕能够引起相同程度(健侧手腕上抬最大范围)的手腕伸展,但不引起疼痛为度,其他刺激参数设置与对照组相同,2组刺激总时间均为10 min。在每项任务中,应用35通道fNIRS测量脑卒中患者双侧前额叶皮层(PFC)、初级运动皮层(M1)和初级感觉皮层(S1)的含氧血红蛋白(HbO2),分析2组总体功能连接(FC)强度和基于感兴趣区域(ROI)水平的功能连接强度平均值的差异。结果:与对照组比较,观察组总体功能连接强度明显更高,健侧初级运动皮层(cM1)与患侧前额叶皮层(iPFC)、cM1与患侧初级运动皮层(iM1)、健侧初级感觉皮层(cS1)与iPFC的FC明显更高,差异具有统计学意义(P<0.05)。结论:CCNMES可通过健侧上肢主动运动触发患侧上肢的感觉运动刺激,并诱导脑卒中偏瘫患者大脑皮质功能重组。Objective:To explore the effect of contralaterally controlled neuromuscular electrical stimulation(CCNMES)on brain functional connectivity of hemiplegic patients after stroke by functional near-infrared spectroscopy(fNIRS).Methods:A total of 48 stroke patients with upper limb hemiplegia in the Rehabilitation Medical Center of Changzhou De'an Hospital from July 2021 to January 2022 were recruited and randomly divided into control group and observation group according to the computer-generated randomization list,with 24 cases in each group.The control group received neuromuscular electrical stimulation(NMES).Two stimulating electrodes were placed on the extensor side of the affected forearm to produce wrist extension,and the stimulation intensity was set at a level that could produce maximum wrist extension without causing discomfort to the patient,with a rectangular pulse of 60 Hz,a pulse width of 200μs,and a stimulation period of 15 s on and 10 s off.The observation group received CCNMES with two surface electrodes and one reference electrode placed on the extensor side of the healthy forearm,and two stimulating electrodes placed on the extensor side of the affected forearm to generate wrist extension.The intensity of stimulation on the affected wrist was set that the affected wrist could be extended to the same extent with the maximum extension of the healthy wrist without causing pain.The other stimulation parameters were the same as those of the control group,and the stimulation duration was 10 minutes in both groups.In each task,the oxygenated hemoglobin(HbO2)in bilateral prefrontal cortex(PFC),primary motor cortex(M1)and primary sensory cortex(S1)of stroke patients were measured by the 35-channel FNIRS,and the differences in overall functional connectivity(FC)strength and mean FC strength based on region of interest(ROI)level between the two groups were analyzed.Results:Compared with the control group,the overall connectivity strength of brain regions in the observation group was higher,the FC in the contra

关 键 词：脑卒中 偏瘫 对侧控制神经肌肉电刺激 功能性近红外光谱成像技术 大脑皮质功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]