双侧上肢经皮穴位电刺激对亚急性脑卒中偏瘫患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2021.11.012

摘要/Abstract

摘要：

目的探讨镜像疗法基础上行双侧上肢经皮穴位电刺激(TEAS)对亚急性期脑卒中偏瘫患者上肢运动功能恢复的影响。方法 2017年9月至2019年10月,48例亚急性期脑卒中偏瘫患者随机分为对照组(n = 24)和观察组(n = 24)。所有患者均给予常规康复和镜像疗法,观察组行双侧上肢TEAS,对照组行假刺激,共4周。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、上肢动作研究量表(ARAT)、Wolf运动功能测试(WMFT)和改良Barthel指数(MBI)进行评定。结果治疗后,两组FMA-UE、ARAT、WMFT和MBI评分均显著改善(|t| > 11.870, P < 0.001),观察组各项评分均高于对照组(|t| > 2.678, P < 0.05)。结论镜像疗法基础上行双侧上肢TEAS可进一步改善亚急性期脑卒中偏瘫患者上肢运动功能,提高患者日常生活活动能力。

关键词: 脑卒中, 经皮穴位电刺激, 镜像疗法, 上肢, 运动

Abstract:

Objective To explore the effects of bilateral arm transcutaneous electrical acupoint stimulation (TEAS) based on mirror therapy (MT) on upper limb function of subacute stroke hemiplegic patients.Methods From September, 2017 to October, 2019, 48 subacute stroke hemiplegic patients were randomly divided into control group (n = 24) and experimental group (n = 24). All the patients accepted routine rehabilitation and MT, while the experimental group received bilateral arm TEAS and the control group received sham TEAS, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT) and modified Barthel Index (MBI) before and after treatment.Results All the scores of FMA-UE, ARAT, WMFT and MBI improved in both groups after treatment (|t| > 11.870, P < 0.001), and improved more in the experimental group than in the control group (|t| > 2.678, P < 0.05).Conclusion Bilateral arm TEAS based on MT can promote the upper limb function of subacute stroke hemiplegic patients.

Key words: stroke, transcutaneous electrical acupoint stimulation, mirror therapy, upper limb, motor

夏道进,熊贤诗,吕玉琴,范荣,彭涛. 双侧上肢经皮穴位电刺激对亚急性脑卒中偏瘫患者上肢功能的效果[J]. 《中国康复理论与实践》, 2021, 27(11): 1318-1322.

XIA Dao-jin,XIONG Xian-shi,LÜ Yu-qin,FAN Rong,PENG Tao. Effects of Bilateral Arm Transcutaneous Electrical Acupoint Stimulation on Upper Limb Function for Subacute Stroke Hemiplegic Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(11): 1318-1322.

图/表 5

表1

表2

表3

表4

表5

参考文献 31

[1]	FEIGIN V L, KRISHNAMURTHI R V, PARMAR P, et al. Update on the Global Burden of Ischemic and Hemorrhagic Stroke in 1990-2013: The GBD 2013 Study[J]. Neuroepidemiology, 2015, 45(3):161-176. doi: 10.1159/000441085
[2]	贾杰. "中枢-外周-中枢"闭环康复-脑卒中后手功能康复新理念[J]. 中国康复医学杂志, 2016, 31(11):1180-1182.
	JIA J. Chin J Rehabil Med, 2016, 31(11):1180-1182.
[3]	唐朝正, 贾杰. 经皮电神经刺激在脑卒中后上肢功能障碍中的应用[J]. 中国康复理论与实践, 2014, 20(4):306-310.
	TANG C Z, JIA J. Application of transcutaneous electrical nerve stimulation in stroke patients with upper extremities dysfunction (review)[J]. Chin J Rehabil Theory Pract, 2014, 20(4):306-310.
[4]	陈瑶, 王鹤玮, 项育枝, 等. 低频经皮穴位电刺激对脑卒中后遗症期手和上肢功能障碍的疗效[J]. 中国康复理论与实践, 2018, 24(12):1371-1375.
	CHEN Y, WANG H W, XIANG Y Z, et al. Effects of low frequency transcutaneous electric acupoint stimulation on upper limbs and hands function for chronic stroke patients[J]. Chin J Rehabil Theory Pract, 2018, 24(12):1371-1375.
[5]	刘慧华, 王颖敏, 何晓阔, 等. 单次电针与经皮穴位电刺激治疗前后体感诱发电位的比较[J]. 中国康复理论与实践, 2017, 23(2):185-188.
	LIU H H, WANG Y M, HE X K, et al. Comparison of electroacupuncture and transcutaneous electrical acupoint stimulation on somatosensory evoked potential[J]. Chin J Rehabil Theory Pract, 2017, 23(2):185-188.
[6]	丁力, 贾杰. "镜像疗法"作为一种康复治疗技术的新进展[J]. 中国康复医学杂志, 2015, 30(5):509-512.
	DING L, JIA J. Chin J Rehabil Med, 2015, 30(5):509-512.
[7]	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. 中国脑出血诊治指南(2014)[J]. 中华神经科杂志, 2015, 48(6):435-444.
	Chinese Society of Neurology, Cerebrovascular Disease Group of Chinese Society of Neurology. Chin J Neurol, 2015, 48(6):435-444.
[8]	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. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4):246-257.
	Chinese Society of Neurology, Cerebrovascular Disease Group of Chinese Society of Neurology. Chin J Neurol, 2015, 48(4):246-257.
[9]	CROW J L, KWAKKEL G, BUSSMANN J B, et al. Are the hierarchical properties of the Fugl-Meyer Assessment scale the same in acute stroke and chronic stroke?[J]. Phys Ther, 2014, 94(7):977-986. doi: 10.2522/ptj.20130170
[10]	NINKOVI M, WEISSENBACHER A, PRATSCHKE J, et al. Assessing the outcome of hand and forearm allotransplantation using the Action Research Arm Test[J]. Am J Phys Rehabil, 2015, 94(3):211-221. doi: 10.1097/PHM.0000000000000151
[11]	WOLF S L, CATLIN P A, ELLIS M, et al. Assessing Wolf Motor Function Test as outcome measure for research in patients after stroke[J]. Stroke, 2001, 32(7):1635-1639. pmid: 11441212
[12]	吴炜, 倪波业, 施加加. 扩展Barthel指数在脑卒中患者中的信度与效度[J]. 中国康复理论与实践, 2021, 27(3):261-268.
	WU W, NI B Y, SHI J J. Reliability and validity of extended barthel index for stroke patients[J]. Chin J Rehabil Theory Pract, 2021, 27(3):261-268.
[13]	《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告2019》概要[J]. 中国脑血管病杂志, 2020, 17(5):272-281.
	Report on Stroke Prevention and Treatment in China Writing Group. Brief Report on Stroke Prevention and Treatmentin China, 2019[J]. Chin J Cerebrovasc Dis, 2020, 17(5):272-281.
[14]	唐千乇, 张通. 脑机接口控制的功能性电刺激对脑卒中患者上肢功能障碍的康复效果[J]. 中国康复理论与实践, 2021, 27(7):802-806.
	TANG Q T, ZHANG T. Effects of functional electrical stimulation controlled by brain-computer interface on upper limb dysfunction in stroke patients[J]. Chin J Rehabil Theory Pract, 2021, 27(7):802-806.
[15]	丁丽君, 荣积峰, 王卫宁, 等. 经皮穴位电刺激对脑卒中后手功能的康复效果[J]. 中国康复理论与实践, 2017, 23(1):10-13.
	DING L J, RONG J F, WANG W N, et al. Effects of transcutaneous electrical acupoint stimulation on hand dysfunction after stroke[J]. Chin J Rehabil Theory Pract, 2017, 23(1):10-13.
[16]	彭源, 张瑾, 苏常春, 等. 经皮穴位电刺激对脑卒中患者上肢功能及运动诱发电位的影响[J]. 中国康复医学杂志, 2015, 30(6):547-550.
	PENG Y, ZHANG J, SU C C, et al. Effects of transcutaneous accupoint electrical stimulation on upper limb function and motor evoked potential in stroke patients[J]. Chin J Rehabil Med, 2015, 30(6):547-550.
[17]	郑雅丹, 胡昔权, 李奎, 等. 双侧上肢训练影响脑梗死患者脑功能重组的fMRI研究[J]. 中华物理医学与康复杂志, 2017, 39(5):336-341.
	ZHENG Y D, HU X Q, LI K, et al. Bilateral arm training and cortical reorganization in cerebral infarction: a functional MRI study[J]. Chin J Phys Med Rehabil, 2017, 39(5):336-341.
[18]	RICHARDSON M C, TEARS C, MORRIS A, et al. The effects of unilateral versus bilateral motor training on upper limb function in adults with chronic stroke: a systematic review[J]. J Stroke Cerebrovasc Dis, 2021, 30(4):105617. doi: 10.1016/j.jstrokecerebrovasdis.2021.105617
[19]	DICKSTEIN R, KAFRI M. Effects of antecedent TENS on EMG activity of the finger flexor muscles and on grip force[J]. Somatosens Mot Res, 2008, 25(2):139-146. doi: 10.1080/08990220802131416
[20]	王东山, 燕铁斌, 陈月桂. 单侧与双侧上肢经皮穴位电刺激对脑卒中患者上肢功能影响的随机对照研究[J]. 中国康复医学杂志, 2010, 25(1):46-49.
	WANG D S, YAN T B, CHEN Y G. Effects of unilateral and bilateral transcutaneous acupoint electrical stimulation on the functional improvement of upper limbs of stroke patients[J]. Chin J Rehabil Med, 2010, 25(1):46-49.
[21]	骆丽, 蔡倩, 孙武东, 等. 双侧训练作为启动训练在脑卒中后重度偏瘫患者上肢康复训练中的临床应用[J]. 中华物理医学与康复杂志, 2018, 40(8):580-582.
	LUO L, CAI Q, SUN W D, et al. Chin J Phys Med Rehabil, 2018, 40(8):580-582.
[22]	孙莉敏, 吴毅, 尹大志, 等. 健康成人在手部主动、被动和想象握拳运动时脑区激活特点的功能性磁共振成像研究[J]. 中华物理医学与康复杂志, 2016, 38(2):126-131.
	SUN L M, WU Y, YIN D Z, et al. Magnetic resonance imaging of active, passive and imaginary movement[J]. Chin J Phys Med Rehabil, 2016, 38(2):126-131.
[23]	蔡伟森, 吴毅, 吴军发, 等. 缺血性脑卒中患者患手主动运动及被动运动时的功能性磁共振研究[J]. 中华物理医学与康复杂志, 2014, 36(4):270-273.
	CAI W S, WU Y, WU J F, et al. Active and passive movement of the affected hand after ischemic stroke[J]. Chin J Phys Med Rehabil, 2014, 36(4):270-273.
[24]	MCCOMBE W S, FORRESTER L, VILLAGRA F, et al. Intracortical inhibition and facilitation with unilateral dominant, unilateral nondominant and bilateral movement tasks in left-and-right-handed adults[J]. J Neurol Sci, 2008, 269(1-2):96-104. doi: 10.1016/j.jns.2007.12.033
[25]	BEHMER L P, FOURNIER L R. Mirror neuron activation as a function of explicit learning: changes in mu-event-related power after learning novel responses to ideomotor compatible, partially compatible, and non compatible stimuli[J]. Eur J Neurosci, 2016, 44(10):2774-2785. doi: 10.1111/ejn.2016.44.issue-10
[26]	陈英伦, 白玉龙. 镜像疗法在脑卒中偏瘫患者运动康复中的研究进展[J]. 中国康复理论与实践, 2018, 24(6):659-666.
	CHEN Y L, BAI Y L. Advance in mirror therapy for motor rehabilitation of stroke patients with hemiplegia (review)[J]. Chin J Rehabil Theory Pract, 2018, 24(6):659-666.
[27]	RAMACHANDRAN V S, ALTSCHULER E L. The use of visual feedback, in particular mirror visual feedback, in restoring brain function[J]. Brain, 2009, 132(7):1693-1710. doi: 10.1093/brain/awp135
[28]	庄金阳, 贾杰. 基于左右制衡理论的镜像疗法在亚急性脑卒中患者的临床应用[J]. 中国康复理论与实践, 2020, 26(1):98-101.
	ZHUANG J Y, JIA J. Application of mirror therapy based on left-right coordination and counterbalance for subacute stroke[J]. Chin J Rehabil Theory Pract, 2020, 26(1):98-101.
[29]	张蕊, 朱美兰, 虞颖, 等. 镜像疗法结合通督醒神针法对脑卒中后上肢功能恢复的影响[J]. 中华物理医学与康复杂志, 2017, 39(8):588-593.
	ZHANG R, ZHU M L, YUN Y, et al. Mirror therapy combined with acupuncture can improve the upper extremity function of stroke survivors[J]. Chin J Phys Med Rehabil, 2017, 39(8):588-593.
[30]	YUN G J, CHUN M H, PARK J Y, et al. The synergic effects of mirror therapy and neuromuscular electrical stimulation for hand function in stroke patients[J]. Ann Rehabil Med, 2011, 35(3):316-321. doi: 10.5535/arm.2011.35.3.316
[31]	陈瑶, 王鹤玮, 项育枝, 等. 低频经皮穴位电刺激在社区脑卒中上肢手功能康复中的近期疗效分析[J]. 中国康复, 2019, 34(12):669-672.
	CHEN Y, WANG H W, XIANG Y Z, et al. Short-term effectiveness of community-based low frequency transcutaneous electric acupoint stimulation on upper limb and hand function rehabilitation in stroke patients[J]. Chin J Rehabil, 2019, 34(12):669-672.

组别	n	性别(男/女, n)	年龄(岁)	病程(周)	性质(梗死/出血,n)
对照组	24	17/7	56.50±7.90	5.20±2.57	12/12
观察组	24	18/6	56.20±9.91	5.00±2.58	15/9
χ²/t值		2.083	0.075	0.173	0.333
P值		0.149	0.941	0.864	0.564

组别	n	治疗前	治疗后	t值	P值
对照组	24	22.40±4.55	31.60±6.04	-12.393	< 0.001
观察组	24	22.60±4.40	41.50±6.80	-15.793	< 0.001
t值		-0.100	-3.441
P值		0.922	0.003

组别	n	治疗前	治疗后	t值	P值
对照组	24	11.10±4.01	20.90±4.56	-25.210	< 0.001
观察组	24	11.20±3.71	26.20±4.29	-38.032	< 0.001
t值		-0.058	-2.678
P值		0.950	0.015

组别	n	治疗前	治疗后	t值	P值
对照组	24	22.40±4.22	34.10±6.61	-13.864	< 0.001
观察组	24	22.70±5.58	47.00±9.43	-17.372	< 0.001
t值		-0.136	-3.543
P值		0.894	0.002

组别	n	治疗前	治疗后	t值	P值
对照组	24	8.00±2.49	17.10±3.78	-11.870	< 0.001
观察组	24	7.50±2.92	24.50±3.03	-43.103	< 0.001
t值		0.412	-4.828
P值		0.685	< 0.001