耳迷走神经电刺激联合双任务训练对缺血性脑卒中患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2025.05.003

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (5): 513-519.doi: 10.3969/j.issn.1006-9771.2025.05.003

• 专题神经电刺激在康复中的应用 • 上一篇下一篇

耳迷走神经电刺激联合双任务训练对缺血性脑卒中患者上肢功能的效果

邹聪聪^1a, 王潇珺^1a, 马锦蓉^1b, 鲁商波^1c, 丁勇^1a, 王哈妮^1a, 宋建飞^1a()

1.浙江康复医疗中心(浙江中医药大学附属康复医院)，a.康复评定与治疗中心; b.老年康复科; c.神经康复科，浙江杭州市 310051

收稿日期:2025-02-05 修回日期:2025-04-07 出版日期:2025-05-25 发布日期:2025-05-26
通讯作者: 宋建飞(1982-)，男，汉族，浙江杭州市人，副主任技师，主要研究方向：神经康复、慢性病康复。E-mail： 1458777383@qq.com
作者简介:邹聪聪(1994-)，女，汉族，浙江温州市人，康复技师，主要研究方向：脑卒中康复。
基金资助:
1.浙江省中医药科技计划项目(2024ZL769);2.浙江省康复医学会科研专项基金项目(ZKKY2023011);3.浙江康复医疗中心院级科研课题(ZKYJ2312)

Effect of transcutaneous auricular vagus nerve stimulation combined with dual-task training on upper limb function in patients with ischemic stroke

ZOU Congcong^1a, WANG Xiaojun^1a, MA Jinrong^1b, LU Shangbo^1c, DING Yong^1a, WANG Hani^1a, SONG Jianfei^1a()

1a. Rehabilitation Assessment and Treatment Center; b. Department of Geriatric Rehabilitation; c. Department of Neurological Rehabilitation, Zhejiang Rehabilitation Medical Center (Rehabilitation Hospital Affiliated to Zhejiang University of Chinese Medicine), Hangzhou, Zhejiang 310051, China

Received:2025-02-05 Revised:2025-04-07 Published:2025-05-25 Online:2025-05-26
Contact: SONG Jianfei, E-mail: 1458777383@qq.com
Supported by:
Zhejiang Province Traditional Chinese Medicine Science and Technology Project(2024ZL769);Zhejiang Rehabilitation Medical Association Research Fund Project(ZKKY2023011);Zhejiang Rehabilitation Medical Center Institutional Research Project(ZKYJ2312)

摘要/Abstract

摘要：

目的探讨耳迷走神经电刺激(taVNS)联合双任务训练(DTT)对缺血性脑卒中患者上肢功能的影响。
方法选取2024年1月至10月浙江康复医疗中心收治的缺血性脑卒中上肢功能障碍患者60例，随机分为对照组(n = 30)和观察组(n = 30)。两组均给予常规康复训练，对照组接受sham-taVNS联合DTT，观察组接受taVNS联合DTT，共4周。治疗前后，采用Fugl-Meyer评定量表上肢部分(FMA-UE)、手臂动作调查测试(ARAT)、改良Barthel指数(MBI)和运动诱发电位(MEP)检测进行评定。
结果治疗后，两组FMA-UE评分、ARAT评分、MBI评分、MEP振幅、MEP潜伏期均明显改善(|t| > 3.670, P < 0.01)，且观察组均明显优于对照组(|t| > 3.081, P < 0.01)。
结论 taVNS联合DTT可以改善缺血性脑卒中患者上肢功能，提升日常生活自理能力，促进神经功能恢复。

关键词: 缺血性脑卒中, 上肢, 功能障碍, 耳迷走神经电刺激, 双任务训练, 运动诱发电位

Abstract:

Objective To explore the effect of transcutaneous auricular vagus nerve stimulation (taVNS) combined with dual-task training (DTT) on upper limb function recovery in patients with ischemic stroke.
Methods From January to October, 2024, 60 ischemic stroke patients with upper limb dysfunction admitted to Zhejiang Rehabilitation Medical Center were selected and randomly divided into control group (n = 30) and observation group (n = 30). Both groups received conventional rehabilitation training. The control group underwent sham-taVNS combined with DTT, while the observation group received active taVNS combined with DTT, for four weeks. Before and after treatment, they were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT), modified Barthel Index (MBI) and motor-evoked potential (MEP) tests.
Results The FMA-UE scores, ARAT scores, MBI scores, MEP amplitude and MEP latency improved in both groups after treatment (|t| > 3.670, P < 0.01), and were superior in the observation group than in the control group (|t| > 3.081, P < 0.01).
Conclusion The combination of taVNS and DTT can significantly improve upper limb function, enhance activities of daily living, and promote neurological recovery in patients with ischemic stroke.

Key words: ischemic stroke, upper limb, dysfunction, transcutaneous auricular vagus nerve stimulation, dual-task training, motor-evoked potential

中图分类号:

R743.3

邹聪聪, 王潇珺, 马锦蓉, 鲁商波, 丁勇, 王哈妮, 宋建飞. 耳迷走神经电刺激联合双任务训练对缺血性脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2025, 31(5): 513-519.

ZOU Congcong, WANG Xiaojun, MA Jinrong, LU Shangbo, DING Yong, WANG Hani, SONG Jianfei. Effect of transcutaneous auricular vagus nerve stimulation combined with dual-task training on upper limb function in patients with ischemic stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(5): 513-519.

图/表 5

表1

表2

两组治疗前后FMA-UE评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	30	前测	24.37±4.51	-5.258	< 0.001
		后测	31.63±5.29
观察组	30	前测	23.80±4.22	-7.392	< 0.001
		后测	36.50±6.85
治疗前两组均值差			0.57±1.13	0.502	0.617
治疗后两组均值差			-4.87±1.58	-3.081	0.003

表2

表3

两组治疗前后ARAT评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	30	前测	20.20±4.05	-3.745	0.001
		后测	24.57±5.06
观察组	30	前测	19.47±4.17	-7.848	< 0.001
		后测	29.63±5.86
治疗前两组均值差			0.73±1.06	0.691	0.492
治疗后两组均值差			-5.07±1.41	-3.584	0.001

表3

表4

两组治疗前后MBI评分比较"

组别	n	测试	$x - ± s$	t值	P值
对照组	30	前测	44.47±6.04	-5.261	< 0.001
		后测	52.80±7.01
观察组	30	前测	44.33±5.25	-14.441	< 0.001
		后测	64.80±8.00
治疗前两组均值差			0.13±1.46	0.091	0.928
治疗后两组均值差			12.00±1.94	-6.179	< 0.001

表4

表5

两组治疗前后MEP检测比较"

变量	组别	n	测试	$x - ± s$	t值	P值
MEP振幅/µV	对照组	30	前测	318.63±109.43	-6.450	< 0.001
			后测	539.40±147.47
	观察组	30	前测	312.40±105.78	-11.984	< 0.001
			后测	712.53±174.45
	治疗前两组均值差			6.23±27.79	0.224	0.823
	治疗后两组均值差			-173.13±41.71	-4.151	< 0.001
MEP潜伏期/ms	对照组	30	前测	28.54±1.52	3.670	0.001
			后测	27.19±1.65
	观察组	30	前测	28.70±1.95	9.087	< 0.001
			后测	25.22±1.46
	治疗前两组均值差			-0.16±0.45	-0.362	0.719
	治疗后两组均值差			1.98±0.40	4.920	< 0.001

表5

参考文献 29

[1]	中国脑卒中防治报告编写组. «中国脑卒中防治报告2021»概要[J]. 中国脑血管病杂志, 2023, 20(11): 783-792.
	Report on Stroke Prevention and Treatment in China Writing Group. Brief Report on Stroke Prevention and Treatment in China, 2021[J]. Chin J Cerebrovasc Dis, 2023, 20(11): 783-792.
[2]	CHIEN W T, CHONG Y Y, TSE M K, et al. Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: a systematic review and meta-analysis[J]. Brain Behav, 2020, 10(8): e1742.
[3]	ALSUBIHEEN A M, CHOI W, YU W, et al. The effect of task-oriented activities training on upper-limb function, daily activities, and quality of life in chronic stroke patients: a randomized controlled trial[J]. Int J Environ Res Public Health, 2022, 19(21): 14125.
[4]	ZHOU Q, YANG H, ZHOU Q, et al. Effects of cognitive motor dual-task training on stroke patients: a RCT-based meta-analysis[J]. J Clin Neurosci, 2021, 92: 175-182. doi: 10.1016/j.jocn.2021.08.009 pmid: 34509248
[5]	BAIG S S, KAMAROVA M, ALI A, et al. Transcutaneous vagus nerve stimulation (tVNS) in stroke: the evidence, challenges and future directions[J]. Auton Neurosci, 2022, 237: 102909.
[6]	中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnostic criteria of cerebrovascular diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[7]	李冬, 张皓, 刘楠, 等. 认知-运动双任务训练对脑卒中恢复期患者平衡功能和步态效果的随机对照试验[J]. 中国康复理论与实践, 2024, 30(9): 1082-1091. doi: 10.3969/j.issn.1006-9771.2024.09.012
	LI D, ZHANG H, LIU N, et al. A randomized controlled trial of effects of cognitive-motor dual task training on balance function and gait in convalescent patients with stroke[J]. Chin J Rehabil Theory Pract, 2024, 30(9): 1082-1091.
[8]	CHEN C L, CHEN C Y, CHEN H C, et al. Responsiveness and minimal clinically important difference of modified Ashworth Scale in patients with stroke[J]. Eur J Phys Rehabil Med, 2019, 55(6): 754-760.
[9]	OUJAMAA L, RELAVE I, FROGER J, et al. Rehabilitation of arm function after stroke. Literature review[J]. Ann Phys Rehabil Med, 2009, 52(3): 269-293. doi: 10.1016/j.rehab.2008.10.003 pmid: 19398398
[10]	KIM H, KIM H K, KIM N, et al. Dual task effects on speed and accuracy during cognitive and upper limb motor tasks in adults with stroke hemiparesis[J]. Front Hum Neurosci, 2021, 15: 671541.
[11]	LI J N, XIE C C, LI C Q, et al. Efficacy and safety of transcutaneous auricular vagus nerve stimulation combined with conventional rehabilitation training in acute stroke patients: a randomized controlled trial conducted for 1 year involving 60 patients[J]. Neural Regen Res, 2022, 17(8): 1809-1813.
[12]	RECH K D, SALAZAR A P, MARCHESE R R, et al. Fugl-Meyer Assessment Scores are related with kinematic measures in people with chronic hemiparesis after stroke[J]. J Stroke Cerebrovasc Dis, 2020, 29(1): 104463.
[13]	DROMERICK A, GEED S, BARTH J, et al. Critical Period After Stroke Study (CPASS): a phase II clinical trial testing an optimal time for motor recovery after stroke in humans[J]. Proc Natl Acad Sci U S A, 2021, 118(39): e2026676118.
[14]	王赛华, 施加加, 孙莹, 等. 简体版改良Barthel指数在脑卒中恢复期中的信度与效度研究[J]. 中国康复, 2020, 35(4): 179-182.
	WANG S H, SHI J J, SUN Y, et al. Reliability and validity of Simplified version modified Barthel Index in the convalescence of stroke[J]. Chin J Rehabil, 2020, 35(4): 179-182.
[15]	施伯瀚, 朱燕, 马书杰, 等. 镜像疗法结合音乐疗法对脑卒中偏瘫患者上肢运动功能的影响[J]. 康复学报, 2023, 33(1): 51-56.
	SHI B H, ZHU Y, MA S J, et al. Effect of image therapy combined with music therapy on upper limb motor function in stroke patients with hemiplegia[J]. Rehabil Med, 2023, 33(1): 51-56.
[16]	林嘉莉, 张舒阳, 林嘉滢, 等. 脑卒中后上肢运动功能与注意力的相关性:一项多中心横断面研究[J]. 中国全科医学, 2025, 28(2): 208-213.
	LIN J L, ZHANG S Y, LIN J Y, et al. Correlation between upper limb motor function and attention after stroke: a multicenter cross-sectional study[J]. Chin Gener Pract, 2025, 28(2): 208-213.
[17]	RICE J, CORP D T, SWAROWSKY A, et al. Greater cognitive-motor interference in individuals post-stroke during more complex motor tasks[J]. J Neurol Phys Ther, 2022, 46(1): 26-33.
[18]	POLLOCK A, FARMER S E, BRADY M C, et al. Interventions for improving upper limb function after stroke[J]. Cochrane Database Syst Rev, 2014, 2014(11): CD10820.
[19]	PARK J. Dual task training effects on upper extremity functions and performance of daily activities of chronic stroke patients[J]. Osong Public Health Res Perspect, 2019, 10(1): 2-5.
[20]	AN H S, KIM D J. Effects of activities of daily living-based dual-task training on upper extremity function, cognitive function, and quality of life in stroke patients[J]. Osong Public Health Res Perspect, 2021, 12(5): 304-313.
[21]	李沁议, 罗思仪, 蒋咏春, 等. 双任务范式在中枢神经疾病中的应用及研究[J]. 康复学报, 2022, 32(5): 462-470.
	LI Q Y, LUO S Y, JIANG Y C, et al. Application and research of dual-task paradigm in central nervous system diseases[J]. Rehabil Med, 2022, 32(5): 462-470.
[22]	ANDALIB S, DIVANI A A, AYATA C, et al. Vagus nerve stimulation in ischemic stroke[J]. Curr Neurol Neurosci Rep, 2023, 23(12): 947-962.
[23]	ZHAO J J, WANG Z H, ZHANG Y J, et al. The mechanisms through which auricular vagus nerve stimulation protects against cerebral ischemia/reperfusion injury[J]. Neural Regen Res, 2022, 17(3): 594-600.
[24]	BIGGIO F, GORINI G, UTZERI C, et al. Chronic vagus nerve stimulation induces neuronal plasticity in the rat hippocampus[J]. Int J Neuropsychopharmacol, 2009, 12(9): 1209-1221. doi: 10.1017/S1461145709000200 pmid: 19309534
[25]	谢敏, 王梦寰, 耿宝峰, 等. 经皮耳迷走神经电刺激联合作业治疗对脑卒中上肢功能的疗效[J]. 中国康复, 2024, 39(11): 649-654.
	XIE M, WANG M H, GENG B F, et al. Effect of percutaneous vagus nerve electrical stimulation combined with operation on upper limb function after stroke[J]. Chin J Rehabil, 2024, 39(11): 649-654.
[26]	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. doi: 10.3969/j.issn.1006-9771.2023.03.006
	ZHANG X F, LIU Y, JIN Z H. Effect of transcutaneous vagus nerve electrical stimulation combined with bilateral upper limb training on upper limb motor function after stroke[J]. Chin J Rehabil Theory Pract, 2023, 29(3): 280-285.
[27]	SHI X, ZHAO J, XU S, et al. Clinical research progress of the post-stroke upper limb motor function improvement via transcutaneous auricular vagus nerve stimulation[J]. Neural Plast, 2023, 2023: 9532713.
[28]	AGER A L, COOLS A M, BORMS D, et al. How does a motor or cognitive dual-task affect our sense of upper limb proprioception[J]. PLoS One, 2024, 19(3): e299856.
[29]	YEN C C, CHEN H H, LEE C H, et al. Predictive value of motor-evoked potentials for motor recovery in patients with hemiparesis secondary to acute ischemic stroke[J]. Ann Med, 2023, 55(1): 2225144.

组别	n	性别(男/女)/n	年龄/岁	病程/d	病灶部位 (左/右)/n	上肢Brunnstrom分期/期
组别	n	性别(男/女)/n	年龄/岁	病程/d	病灶部位 (左/右)/n	Ⅰ	Ⅱ	Ⅲ	Ⅳ	Ⅴ	Ⅵ
对照组	30	17/13	53.93±9.91	90.47±39.69	18/12	0	17	8	5	0	0
观察组	30	16/14	53.97±10.18	87.03±40.74	14/16	0	15	11	4	0	0
χ²/t值		0.067	-0.013	0.331	1.071	-0.303
P值		0.795	0.990	0.742	0.301	0.762

耳迷走神经电刺激联合双任务训练对缺血性脑卒中患者上肢功能的效果

Effect of transcutaneous auricular vagus nerve stimulation combined with dual-task training on upper limb function in patients with ischemic stroke

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 29

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	柏敏, 曹丽华, 叶子琦, 周定杰, 李雪萍. 肌电感知机器人辅助训练联合成对关联刺激对脑卒中偏瘫患者上肢功能的影响[J]. 《中国康复理论与实践》, 2025, 31(5): 505-512.
[2]	耿阿燕, 王庆雷, 沈俊帆, 朱仕哲, 季盼盼, 王彤, 郭川. 时间间隔对持续性θ爆发刺激预调控间歇性θ爆发刺激诱导运动皮质可塑性的影响[J]. 《中国康复理论与实践》, 2025, 31(5): 607-612.
[3]	易玲, 周静, 陈雪芬, 陈川帆, 陈科伊, 董慧繁. 基于ICF的智力残疾儿童言语功能障碍和沟通活动受限特征与康复干预[J]. 《中国康复理论与实践》, 2025, 31(4): 398-405.
[4]	李鑫磊, 魏伟, 宋健, 赵雨晴, 孔维橙, 蔡嘉玉, 施浩然, 薛偕华. 静息态脑电图在脑卒中患者上肢运动功能评估中的应用[J]. 《中国康复理论与实践》, 2025, 31(4): 448-457.
[5]	化龙昂, 赖海芳, 杨威, 刘勇, 叶祥明. 耳迷走神经电刺激对慢性意识障碍促醒的效果[J]. 《中国康复理论与实践》, 2025, 31(3): 339-347.
[6]	耿文慧, 周严红, 尹俊普, 韩磊, 高阳. 乳腺癌术后肩关节活动度分析[J]. 《中国康复理论与实践》, 2025, 31(3): 356-364.
[7]	王潇珺, 王哈妮, 俞红, 李元梅, 周煜达. 高精度经颅直流电刺激联合上肢机器人对缺血性脑卒中上肢功能的效果[J]. 《中国康复理论与实践》, 2025, 31(2): 218-224.
[8]	常冉, 靖华芳, 高轶, 张思雨, 王越, 吴娟. 膀胱变形指数对神经源性膀胱患者上尿路损伤的预测价值[J]. 《中国康复理论与实践》, 2025, 31(2): 231-234.
[9]	秦晴, 刘叶, 叶海燕, 李晨, 陈迪. 上肢机器人辅助干预脑卒中的文献计量分析[J]. 《中国康复理论与实践》, 2025, 31(1): 85-98.
[10]	罗红, 徐丽. 重复经颅磁刺激联合重复外周磁刺激对脑出血患者上肢运动功能的效果：基于静息态功能磁共振成像的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(9): 1060-1068.
[11]	王敏, 方篮天, 黄晨燚. 改良分级运动表象训练对脑卒中患者上肢运动功能效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(9): 1069-1073.
[12]	李冬, 张皓, 刘楠, 王昕悦, 徐淼. 认知-运动双任务训练对脑卒中恢复期患者平衡功能和步态效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(9): 1082-1091.
[13]	于婷婷, 蔡福良, 缪桂华, 顾晨, 彭媛. 基于个性优势的结构化治疗与教育对缺血性脑卒中康复效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(8): 965-971.
[14]	梁天佳, 龙耀斌, 陆丽燕, 周金英, 黄福才, 黄林鹏, 邬映超, 龙耀翔, 韦小翠, 柳忠. 绳带辅助本体感觉神经肌肉促进技术训练联合绳带辅助脑机接口训练对脑卒中偏瘫上肢康复效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(8): 972-978.
[15]	何爱群, 黎景波, 何茂莉, 叶思媚, 宋秋爽, 刘海鸥, 谢有书. 作业技能再学习策略对脑卒中偏瘫上肢功能效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(7): 823-830.