经皮耳迷走神经电刺激对缺血性卒中患者的康复疗效观察  

Efficacy of transcutaneous auricular vagus nerve stimulation for rehabilitation of patients with ischemic stroke

作　　者：马丽[1] 封亮 赵曦[2] 余斌[2] MA Li;FENG Liang;ZHAO Xi;YU Bin(School of Medicine,Tongji University,Shanghai 200092,China;Department of Anesthesia Pain Rehabilitation,Yangzhi Rehabilitation Hospital,Tongji University,Shanghai 201600,China)

机构地区：[1]同济大学医学院,上海200092 [2]同济大学附属养志康复医院麻醉疼痛康复科,上海201600

出　　处：《同济大学学报（医学版）》2024年第3期404-410,共7页Journal of Tongji University(Medical Science)

基　　金：上海市重中之重康复医学研究中心(2023ZZ02027)。

摘　　要：目的探讨不同频率的经皮耳迷走神经电刺激(transcutaneous auricular vagus nerve stimulation,taVNS)结合康复运动对缺血性卒中患者康复疗效的影响。方法选取2023年6月—10月同济大学附属养志康复医院神经内科收治的80例缺血性脑卒中后伴上肢偏瘫患者,随机分为taVNS 0 Hz(n=20)、taVNS 30 Hz组(n=20)、taVNS 300 Hz组(n=20)、taVNS 3000 Hz(n=20)组,4组均接受常规康复训练,同时增加不同频率的taVNS刺激,根据患者耐受情况调整ta-VNS治疗强度,每次30 min,每日1次,连续治疗14 d。在假刺激组中,只夹电极但不给与刺激。分别记录治疗前、治疗30 d、治疗45 d后简式Fugl-Meyer(FMA)运动功能评分。结果治疗前4组FMA评分无显著差异(F=0.195,P=0.900);重复测量方差分析结果显示,治疗30 d及45 d后,4组FMA评分均较治疗前显著提高(P<0.001),同时taVNS 300 Hz组治疗45 d后的FMA评分最优(48.81±20.30);不同治疗方案在治疗30 d前后、治疗45 d前后FMA指标的差值均具有差异(P<0.001),其中taVNS 300 Hz组治疗45 d前后的FMA评分差值最大(9.81±1.69),具有临床意义。结论taVNS结合康复运动能促进缺血性卒中患者的运动功能康复,taVNS 300 Hz治疗组效果最优。Objective To investigate the efficacy of transcutaneous auricular vagus nerve stimulation(taVNS)for motor function rehabilitation in patients with ischemic stroke.Methods From June,2023 to October,eighty ischemic stroke patients admitted in the Department of Neurology of Yangzhi Rehabilitation Hospital affiliated to Tongji University were randomly divided into 4 groups with 20 cases in each group.All patients received routine rehabilitation exercise;in addition,patients in different groups received taVNS 0 Hz(control group),30 Hz,300 Hz or 3000 Hz,respectively.According to the patient's tolerance,the treatment intensity of ta-VNS was 30 min/d for 14 d.The scores of simplified Fugl-Meyer Assessment Extremities(FMA)were evaluated before treatment,30 d and 45 d after treatments.Results There was no significant difference in FMA score among 4 groups before treatment(F=0.195,P=0.900),while the FMA scores 30 d or 45 d after treatment were significantly higher than those before treatment in all groups(P<0.001).The FMA score of the taVNS 300 Hz group was the best 45 d after treatment(48.81±20.30,P<0.001).The differences of FMA scores before and 30 d or 45 d after treatment varied significantly among groups(P<0.001),while the difference of FMA score before and 45 d after treatment in the taVNS 300 Hz group was the largest(9.81±1.69,P<0.001),which was of clinical significance.Conclusion Transcutaneous auricular vagus nerve stimulation combined with rehabilitation exercise can effectively promote motor function rehabilitation in patients with ischemic stroke,and the effect of taVNS 300 Hz treatment group is the best.

关 键 词：缺血性卒中 经皮耳迷走神经电刺激 康复 

分 类 号：R743.3[医药卫生—神经病学与精神病学]