经外耳皮肤迷走神经电刺激联合双侧上肢训练对脑卒中上肢运动功能的效果

doi:10.3969/j.issn.1006-9771.2023.03.006

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (3): 280-285.doi: 10.3969/j.issn.1006-9771.2023.03.006

• 专题非侵入式神经调控技术在康复中的应用 • 上一篇下一篇

经外耳皮肤迷走神经电刺激联合双侧上肢训练对脑卒中上肢运动功能的效果

章晓峰(), 刘勇, 金振华

浙江省人民医院康复医学中心，浙江省康复与运动医学研究所，杭州医学院附属人民医院康复医学科，浙江杭州市 310014

收稿日期:2022-04-26 修回日期:2023-03-01 出版日期:2023-03-25 发布日期:2023-04-14
通讯作者: 章晓峰 E-mail:zhangxiaofengmengn@163.com
作者简介:章晓峰(1986-)，男，汉族，浙江杭州市人，硕士，主管技师，主要研究方向：偏瘫康复。
基金资助:
1.浙江省基础公益研究计划项目(LGF21H170005);2.浙江省医药卫生科技厅计划项目(2021KY530)

Effect of transcutaneous auricular vagus nerve stimulation combined with bilateral arm training on upper limb motor function of stroke patients

ZHANG Xiaofeng(), LIU Yong, JIN Zhenhua

Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang 310014, China

Received:2022-04-26 Revised:2023-03-01 Published:2023-03-25 Online:2023-04-14
Contact: ZHANG Xiaofeng E-mail:zhangxiaofengmengn@163.com
Supported by:
Zhejiang Basic Public Welfare Research Program(LGF21H170005);Zhejiang Medical and Health Science and Technology Plan(2021KY530)

摘要/Abstract

摘要：

目的探讨经外耳皮肤迷走神经电刺激(taVNS)联合双侧上肢训练(BAT)对脑卒中患者上肢运动功能的影响。

方法选取2021年1月至2022年1月浙江省人民医院康复医学科的105例脑卒中住院患者，随机分为taVNS组、BAT组和联合组，每组35例。3组均接受常规康复治疗，taVNS组增加taVNS，BAT组增加BAT，联合组同时增加taVNS和BAT，共8周。治疗前后，采用表面肌电图测量三角肌、肱三头肌和伸腕肌的均方根(RMS)，采用盒子积木试验(BBT)和Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定。

结果治疗后，3组各肌肉RMS、BBT评分和FMA-UE评分均较治疗前显著提高(|t| > 6.124, P < 0.001)，联合组最优(F > 18.162, P < 0.001)。

结论 taVNS和BAT均可改善脑卒中患者患侧上肢肌力，提高手的灵活度和上肢运动功能；两者联合使用效果更佳。

关键词: 脑卒中, 经外耳皮肤迷走神经电刺激, 双侧上肢训练, 上肢, 运动功能

Abstract:

Objective To investigate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) combined with bilateral arm training (BAT) on upper limb motor function of hemiplegic stroke patients.

Methods From January, 2021 to January, 2022，105 stroke patients from Zhejiang Provincial People's Hospital were randomly divided into taVNS group (n = 35), BAT group (n = 35) and combined group (n = 35). All the patients received routine rehabilitation, while taVNS group received taVNS, BAT group received BAT, and the combined group received both taVNS and BAT, for eight weeks. The root mean square (RMS) of surface electromyography in deltoid, triceps brachii and extensor carpi was measured, and the scores of Box and Block Test (BBT), and Fugl-Meyer Assessment-Upper Extremities (FMA-UE) were obtained before and after treatment.

Results The RMS of all these muscles, and the scores of BBT and FMA-UE improved in all the three groups after treatment (|t| > 6.124, P< 0.001), and they were improved the most in the combined group (F > 18.162, P< 0.001).

Conclusion Both taVNS and BAT can enhance the muscle strength on the affected upper limb, increase the hand flexibility, and improve upper limb motor function of stroke patients, while the combination of both methods is more effective.

Key words: stroke, transcutaneous auricular vagus nerve stimulation, bilateral arm training, upper limb, motor function

中图分类号:

R743.3

章晓峰, 刘勇, 金振华. 经外耳皮肤迷走神经电刺激联合双侧上肢训练对脑卒中上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(3): 280-285.

ZHANG Xiaofeng, LIU Yong, JIN Zhenhua. Effect of transcutaneous auricular vagus nerve stimulation combined with bilateral arm training on upper limb motor function of stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 280-285.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	偏瘫侧(左/右)/n	Brunnstrom分期 (Ⅰ/Ⅱ/Ⅲ/Ⅳ)/n
taVNS组	35	15/20	58.94±12.12	39.74±17.76	17/18	6/13/14/2
BAT组	35	18/17	56.60±13.23	38.69±15.01	15/20	4/15/12/4
联合组	35	19/16	57.63±13.72	42.20±18.66	21/14	7/12/15/1
χ²/F/H值		0.536	0.299	0.384	2.134	0.450
P值		0.765	0.742	0.682	0.344	0.799

组别	n	治疗前	治疗后	t值	P值
taVNS组	35	17.35±4.71	26.57±5.32	-7.676	< 0.001
BAT组	35	17.87±4.57	31.95±6.14	-10.438	< 0.001
联合组	35	16.94±5.19	35.63±1.24^a,b	-11.197	< 0.001
F值		0.327	18.162
P值		0.722	< 0.001

组别	n	治疗前	治疗后	t值	P值
taVNS组	35	9.22±2.64	23.32±4.15	-16.612	< 0.001
BAT组	35	9.17±2.48	26.32±4.87	-18.374	< 0.001
联合组	35	9.53±2.78	30.82±5.64^a,b	-20.443	< 0.001
F值		0.186	20.502
P值		0.830	< 0.001

组别	n	治疗前	治疗后	t值	P值
taVNS组	35	8.36±2.24	17.84±3.89	-12.447	< 0.001
BAT组	35	8.54±2.31	22.43±4.59	-16.512	< 0.001
联合组	35	8.81±2.43	27.78±44.86^a,b	-20.229	< 0.001
F值		0.347	43.410
P值		0.708	< 0.001

组别	n	治疗前	治疗后	t值	P值
taVNS组	35	3.74±1.88	12.54±4.26	-9.660	< 0.001
BAT组	35	3.86±1.68	15.34±4.14	-14.090	< 0.001
联合组	35	3.77±1.85	17.51±3.76^a,b	-220.657	< 0.001
F值		0.038	67.796
P值		0.963	< 0.001

经外耳皮肤迷走神经电刺激联合双侧上肢训练对脑卒中上肢运动功能的效果

Effect of transcutaneous auricular vagus nerve stimulation combined with bilateral arm training on upper limb motor function of stroke patients

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组别	n	治疗前	治疗后	t值	P值
taVNS组	35	25.23±4.52	32.37±5.92	-6.124	< 0.001
BAT组	35	24.95±4.82	39.53±5.24	-13.193	< 0.001
联合组	35	24.35±5.39	44.91±7.12^a,b	-15.777	< 0.001
F值		0.292	36.689
P值		0.747	< 0.001

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