基于功能性近红外光谱技术探索脑卒中恢复期患者障碍躲避时皮层激活的相关性研究  

Cortical activation during obstacle avoidance in convalesent stroke patients:A fNIRS study

作　　者：毛佳燕 王心愿 刘文兵[3] 徐彬[1,2] 周煜达 龚怡辰 章水晶[1,2] 张淑青[3] 钱志勇 邱纪方 MAO Jiayan;WANG Xinyuan;LIU Wenbing(The Affiliated Rehabilitation Hospital of Zhejiang Chinese Medical University(Zhejiang Rehabilitation Medical Center),Hangzhou,310052)

机构地区：[1]浙江中医药大学附属康复医院(浙江康复医疗中心),浙江省杭州市310052 [2]浙江中医药大学第三临床医学院、康复医学院 [3]浙江中医药大学附属第三医院

出　　处：《中国康复医学杂志》2025年第3期382-388,共7页Chinese Journal of Rehabilitation Medicine

基　　金：2021年浙江省卫生健康科技计划项目面上项目(2021KY959)。

摘　　要：目的:探索脑卒中恢复期患者在执行障碍躲避任务时,大脑皮层的激活情况,以及避障难度对脑区激活的影响。方法:令20例脑卒中恢复期患者,执行相关试验任务(包括单纯步行、简单避障、困难避障、运动想象)。同时,利用功能性近红外光谱技术(f NIRS),对其大脑前额叶皮层(PFC)、运动前皮质(PMC)、辅助运动区(SMA)的氧合血红蛋白浓度进行检测。收集相关次要指标。在不分组及分组情况下分别进行统计分析。结果:双侧PFC、PMC、SMA的激活程度在各运动态任务与静态任务之间有显著性差异(P<0.05),且PFC激活程度较高。其中在非受累侧SMA,简单避障与困难避障任务之间存在显著性差异(P<0.05)。此外,非受累侧PMC的最大激活程度与Tinetti评分之间存在线性正相关(P<0.05)。结论:双侧PFC、PMC、SMA在脑卒中恢复期患者肢体运动时可能均发挥作用,且PFC激活程度较高。另外,非受累侧SMA则可能在避障难度的调节中起作用。并且,患者非受累侧PMC的最大激活程度则与其平衡及步行能力有关。Objective:To explore cortical activation during the obstacle avoidance task in convalescent stroke patients,and examine the effect of obstacle avoidance difficulty on brain activation.Method:A total of 20 convalescent stroke patients were recruited to perform various motor tasks,including walking,simple obstacle avoidance,difficult obstacle avoidance,and motor imagery.Functional near-infrared spectroscopy(fNIRS)was used to detect the oxygenated hemoglobin concentration in the prefrontal cortex(PFC),premotor cortex(PMC)and supplementary motor area(SMA)of the patients.Additional relevant secondary indicators were evaluated and collected.Statistical analysis was performed without grouping and with grouping.Result:The activation levels of bilateral PFC,PMC and SMA during the dynamic task were significantly different from those during the static tasks(P<0.05),with the highest activation observed in the PFC.There were significant differences between simple and difficult obstacle avoidance tasks in the unaffected-side SMA(P<0.05).In addition,there was a linear positive correlation between the peak activation level of PMC on the unaffected side and Tinetti score(P<0.05).Conclusion:Bilateral PFC,PMC and SMA are involved in limb movement in convalescent stroke patients,with PFC showing the highest level of activation.In addition,SMA on the unaffected side may contribute to regulating the difficulty of obstacle avoidance.Moreover,the peak activation level of PMC on the unaffected side is associated with balance and walking function.

关 键 词：脑卒中恢复期 障碍躲避 功能性近红外光谱技术 皮层激活 

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]