基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺干预脑卒中患者中枢及上肢功能的效果

doi:10.3969/j.issn.1006-9771.2023.08.008

摘要/Abstract

摘要：

目的观察基于“中枢-外周-中枢”理论的经颅直流电刺激(tDCS)结合针刺对弛缓期脑卒中患者中枢及上肢功能的效果。
方法 2018年9月至2021年12月，广东省工伤康复医院脑卒中康复科和颅脑损伤康复科的脑卒中后上肢功能障碍患者120例，随机分为对照组1 (n = 40)、对照组2 (n = 40)和试验组(n = 40)。3组均给予常规康复治疗，对照组1给予针刺治疗，对照组2给予阳极tDCS，试验组给予两者结合治疗，共4周。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)和改良Barthel指数(MBI)进行评定，脑电图检测脑对称指数(BSI)，肌电图检测患侧上肢肱三头肌、肱二头肌、腕伸肌、腕屈肌群均方根值(RMS)。
结果对照组1脱落2例，对照组2和试验组各脱落1例。治疗后，各组FMA-UE和MBI评分均显著升高(t > 11.757, P < 0.001)，试验组评分显著高于对照组1和对照组2 (P < 0.001);对照组2和试验组脑电BSI下降(t > 2.324, P < 0.05)，试验组BSI低于对照组2 (P < 0.05);各组肱二头肌肌电RMS均明显增加(t > 2.953, P < 0.01)，试验组大于对照组1和对照组2 (P < 0.05);对照组1和试验组腕屈肌和肱三头肌肌电RMS增加(t > 2.230, P < 0.05)，且试验组高于对照组1 (P < 0.05);仅试验组腕伸肌肌电RMS明显增加(t = 3.350, P < 0.01)。
结论基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺可以有效改善弛缓期脑卒中患者上肢功能，改善大脑半球不对称性，提升患侧上肢肌群的激活水平。

关键词: 脑卒中, 上肢, 运动功能, 经颅直流电刺激, 针刺, 脑电, 肌电

Abstract:

Objective To explore the effect of transcranial direct current stimulation (tDCS) combined with acupuncture on central and upper limb function in stroke patients at flaccid stage based on central-peripheral-central theory.
Methods From September, 2018 to December, 2021, 120 patients with upper limb dysfunction after stroke in Guangdong Work Injury Rehabilitation Hospital were selected and randomly divided into control group 1 (n = 40), control group 2 (n = 40) and experimental group (n = 40). All the groups received conventional rehabilitation treatment. In addition, the control group 1 received acupuncture treatment, the control group 2 received anodal tDCS, and the experimental group received combined treatment of both, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment. Electroencephalograph (EEG) was used to detect brain symmetry index (BSI), and electromyography (EMG) was used to detect root mean square values (RMS) of triceps brachii, biceps brachii, extensor wrist and flexor wrist of the affected upper limbs.
Results Two cases in the control group 1, one in the control group 2 and one in the experimental group dropped off, respectively. After treatment, the scores of FMA-UE and MBI significantly increased in all the groups (t > 11.757, P < 0.001), and they were higer in the experimental group than in the control groups (P < 0.001); the BSI decreased in the control group 2 and the experimental group (t > 2.324, P < 0.05), and it was less in the experimental group than in the control group 2 (P < 0.05); the RMS of biceps increased in all the groups (t > 2.953, P < 0.01), and was higer in the experimental group than in the control groups (P < 0.05); the RMS of flexor wrist and triceps increased in the control group 1 and the experimental group (t > 2.230, P < 0.05), and were higher in the experimental group than in the control group 1 (P < 0.05); the RMS of wrist extensor muscle increased only in the experimental group (t = 3.350, P < 0.01).
Conclusion tDCS combined with acupuncture based on central-peripheral-central theory could effectively improve the upper limb function of stroke patients at flaccid stage, with advantages in improving hemispheric asymmetry and enhancing the activation level of affected muscles.

Key words: stroke, upper limb, motor function, transcranial direct current stimulation, acupuncture, electroencephalogram, electromyography

中图分类号:

R743.3

王海云, 王寅, 周信杰, 何爱群. 基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺干预脑卒中患者中枢及上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 919-925.

WANG Haiyun, WANG Yin, ZHOU Xinjie, HE Aiqun. Effect of transcranial direct current stimulation combined with acupuncture on central and upper limb function in stroke patients based on central-peripheral-central theory[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 919-925.

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组别	n	性别(男/女)/n	年龄/岁	病程/月	受损半球(左/右)/n
对照组1	40	22/18	56.68±6.23	1.16±0.64	23/17
对照组2	40	23/17	54.07±6.15	1.30±0.71	18/22
试验组	40	25/15	60.25±5.84	1.15±0.78	22/18
F/χ²值		0.639	1.928	1.035	1.538
P值		0.725	0.086	0.391	0.482

组别	n	治疗前	治疗后	t值	P值
对照组1	38	8.53±3.95	25.39±6.42	13.952	< 0.001
对照组2	39	8.41±3.53	28.14±4.42	22.263	< 0.001
试验组	39	8.47±3.73	32.47±6.15^a,b	19.914	< 0.001
F值		0.011	15.438
P值		0.989	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组1	38	31.14±7.72	58.78±10.93	12.693	< 0.001
对照组2	39	29.49±9.99	56.91±11.12	11.757	< 0.001
试验组	39	31.83±5.45	70.56±10.93^a,b	23.074	< 0.001
F值		0.104	17.873
P值		0.901	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组1	38	0.16±0.04	0.16±0.03	0.139	0.890
对照组2	39	0.15±0.03	0.14±0.03	2.324	0.026
试验组	39	0.15±0.03	0.12±0.03^a	5.512	0.003
F值		1.250	12.581
P值		0.291	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组1	38	8.26±5.10	12.79±4.94	4.020	< 0.001
对照组2	39	8.16±5.62	11.48±4.68	2.953	0.005
试验组	39	9.12±5.39	17.06±5.33^a,b	7.399	< 0.001
F值		0.431	13.208
P值		0.651	< 0.001