基于双峰平衡恢复模型的经颅直流电刺激对缺血性脑卒中患者上肢功能障碍的效果

doi:10.3969/j.issn.1006-9771.2025.11.004

摘要/Abstract

摘要：

目的探究基于双峰平衡恢复模型的经颅直流电刺激(tDCS)在改善缺血性脑卒中患者上肢功能障碍中的临床价值。

方法 2023年10月至2024年12月，选取宁夏医科大学总医院60例缺血性脑卒中患者，随机分为对照组和试验组，各30例。两组均接受常规康复治疗，在此基础上，对照组应用基于半球间竞争模型理论下的tDCS治疗方案，试验组采用基于双峰平衡恢复模型理论下的tDCS治疗方案，共4周。干预前后分别采用Fugl-Meyer评定量表上肢部分(FMA-UE)、改良Ashworth分级量表(MAS)、上肢动作研究量表(ARAT)和改良Barthel指数(MBI)进行评价，检测运动诱发电位皮质潜伏期(CL)、中枢运动传导时间(CMCT)等神经电生理参数，并进行相关性分析。

结果对照组脱落2例，试验组脱落1例。治疗后，两组FMA-UE、ARAT和MBI评分均显著提高(|t| > 13.748, P < 0.001)，试验组高于对照组(|t| > 2.321, P < 0.05)；试验组屈肘肌群MAS等级改善(|Z| = 2.095, P < 0.05)；两组CL、CMCT值显著降低(|t| > 2.752, P < 0.001)，试验组改善程度优于对照组(|t| > 2.082, P < 0.05)；FMA-UE评分差值与CMCT差值呈负相关(r = -0.433, P < 0.05)。

结论基于双峰平衡恢复模型的tDCS改善缺血性脑卒中患者上肢功能障碍的效果更佳。

关键词: 缺血性脑卒中, 上肢, 经颅直流电刺激, 双峰平衡

Abstract:

Objective To explore the clinical effect of transcranial direct current stimulation (tDCS) treatment strategy based on bimodal balance model on upper limb dysfunction after ischemic stroke.

Methods From October, 2023 to December, 2024, 60 patients with ischemic stroke in General Hospital of Ningxia Medical University were randomly divided into control group (n = 30) and experimental group (n = 30). Both groups received basic rehabilitation, the control group received tDCS based on the theory of interhemispheric competition model, and the experimental group received tDCS based on the theory of bimodal equilibrium model, for four weeks. Before and after intervention, the effect of both groups was evaluated using Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Ashworth Scale (MAS), Action Research Arm Test (ARAT) and modified Barthel Index (MBI). Neurophysiological parameters such as cortical latency (CL) and central motor conduction time (CMCT) were detected and correlated analysis was performed.

Results Two cases in the control group and one in the experimental group dropped down. After intervention, the scores of FMA-UE, ARAT and MBI increased in both groups (|t| > 13.748, P< 0.001), and the above scores were higher in the experimental group than in the control group (|t| > 2.321, P< 0.05); the MAS grade of the elbow flexor muscle group improved in the experimental group (|Z| = 2.095, P< 0.05). The CL and CMCT in both groups decreased (|t| > 2.752, P< 0.001), and they were better in the experimental group than in the control group (|t| > 2.082, P< 0.05). There was a correlation between FMA-UE and CMCT (r = -0.433, P< 0.05).

Conclusion tDCS based on bimodal balance model can improve upper limb dysfunction more effectively in patients with ischemic stroke.

Key words: ischemic stroke, upper limb, transcranial direct current stimulation, bimodal balance model

中图分类号:

R743.3

田富宝, 李泓钰, 田洋, 许宁, 李珂, 白川萍, 杨彩军. 基于双峰平衡恢复模型的经颅直流电刺激对缺血性脑卒中患者上肢功能障碍的效果[J]. 《中国康复理论与实践》, 2025, 31(11): 1271-1278.

TIAN Fubao, LI Hongyu, TIAN Yang, XU Ning, LI Ke, BAI Chuanping, YANG Caijun. Effect of transcranial direct current stimulation based on bimodal balance model on upper limb dysfunction after ischemic stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(11): 1271-1278.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	偏瘫侧(左/右)/n
对照组	30	21/9	57.60±10.28	24.73±16.91	18/12
试验组	30	23/7	53.20±12.08	25.10±16.45	16/14
χ²/t值		0.341	1.529	-0.085	0.271
P值		0.559	0.134	0.932	0.602

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	28	前测	20.39±2.94	-17.823	< 0.001
		后测	28.36±3.22
试验组	29	前测	24.14±12.06	-17.004	< 0.001
		后测	34.48±10.11
治疗前两组均值差			-3.75±2.31	-1.623	0.115
治疗后两组均值差			-6.13±1.97	-3.104	0.004

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	28	前测	8.86±2.17	-13.748	< 0.001
		后测	11.36±2.22
试验组	29	前测	8.72±2.05	-19.250	< 0.001
		后测	12.66±2.01
治疗前两组均值差			0.133±0.559	0.238	0.813
治疗后两组均值差			-1.290±0.559	-2.321	0.024

项目	时间	n	对照组(n = 28)												组内比较		组间比较
项目	时间	n	0	I	I^＋	II	III	IV	0	I	I^＋	II	III	IV	Z值	P值	Z值	P值
屈肘肌
	治疗前	28	13	5	7	3	0	0	11	7	8	3	0	0			-0.430	0.667
	治疗后	28	14	7	6	1	0	0	17	9	2	1	0	0			-0.955	0.340
															-1.028	0.304
															-2.095	0.036
屈腕肌
	治疗前	29	13	3	10	2	0	0	15	7	5	2	0	0			-0.827	0.408
	治疗后	29	14	8	5	1	0	0	16	12	1	0	0	0			-0.949	0.343
															-0.949	0.343
															-0.932	0.351

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	28	前测	30.18±3.55	-34.588	< 0.001
		后测	57.43±4.42
试验组	29	前测	31.03±2.16	-28.786	< 0.001
		后测	60.97±5.76
治疗前两组均值差			-0.856±0.775	-1.104	0.274
治疗后两组均值差			-3.537±1.357	-2.595	0.012