脑梗死恢复早期患者肘关节屈伸任务下皮质激活特征的功能性近红外光谱研究  

Cerebral activation under elbow flexion and extension tasks for patients with stoke after early rehabilitation:a functional near infrared spectroscopy study

作　　者：蒋金金 张玉婷 王璐怡 汪杰 JIANG Jinjin;ZHANG Yuting;WANG Luyi;WANG Jie(Rehabilitation Center,Beijing Rehabilitation Hospital Affiliated to Capital Medical University,Beijing 100144,China)

机构地区：[1]首都医科大学附属北京康复医院康复诊疗中心,北京市100144

出　　处：《中国康复理论与实践》2024年第12期1436-1441,共6页Chinese Journal of Rehabilitation Theory and Practice

基　　金：首都医科大学附属北京康复医院引进人才科研启动基金项目(No.2022R-004)。

摘　　要：目的 观察脑梗死患者恢复早期的脑功能重组。方法 2023年4月至2024年4月,选择首都医科大学附属北京康复医院住院的右半球脑梗死患者20例(试验组),病程2~4周,左侧重度偏瘫;20例健康受试者作为对照组。所有被试完成模块设计左侧屈肘任务,进行功能性近红外光谱检查;对照组只完成1次检查;试验组每2周检查1次,共5次,计算偏侧化指数;并于每次检查前采用Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定。结果 FMA-UE评分逐渐上升(P<0.05);偏侧化指数显示,试验组全脑、初级运动皮质和辅助运动区由右侧优势逐渐趋于平衡,背外侧前额叶皮质由平衡转为右侧优势,前运动皮质从右侧优势转为左侧优势。结论 脑卒中患者恢复早期,随着上肢运动功能改善,多数运动皮质区从患侧优势激活逐步转为左右平衡激活;但少数脑区可能转变为健侧或患侧优势激活。Objective To observe the rule of functional reorganization in stroke patients during early recovery.Methods From April,2023 to April,2024,20 patients with serious left hemiplegia for right cerebral infarction of two to four weeks were included as experimental group,from Beijing Rehabilitation Hospital Affiliated to Capital Medical University;meanwhile,20 healthy subjects were included as control group.All the subjects finished a block designed left elbow flexing task,and were measured with functional near-infrared spectroscopy.The control group finished the test once;and the experimental group finished the test once per two weeks,for five times,and laterality indexes were calculated;they were also assessed with Fugl-Meyer Assessment-Upper Extremity(FMAUE)before each test.Results The score of FMA-UE increased time by time(P<0.05).For the experimental group,laterality index showed that the activation shifted from right dominance to balance in the whole brain,primary motor cortex and supplementary motor area;and it shifted from balance to right dominance in dorsolateral prefrontal cortex,and form right dominance to left dominance in premotor cortex.Conclusion At the early recovery stage of stroke patients,the upper limb motor function is gradually improving,with the activation in most motor cortex shifting from affected hemisphere dominance to bilateral hemisphere balance;however,the activation may become affected or unaffected dominance in some brain areas.

关 键 词：脑卒中 运动功能 脑激活 功能性近红外光谱 偏侧化指数 

分 类 号：R743.3[医药卫生—神经病学与精神病学]