不同电极经颅直流电刺激对脑卒中上肢功能康复的效果

doi:10.3969/j.issn.1006-9771.2023.05.005

摘要/Abstract

摘要：

目的观察阳极经颅直流电刺激(tDCS)和阴极tDCS对脑卒中后上肢功能中、重度瘫痪患者的疗效。

方法 2022年1月至9月，选取东南大学附属中大医院脑卒中患者69例，随机数字表法分为对照组(n = 23)、阳极组(n = 23)和阴极组(n = 23)。3组均接受常规药物治疗和康复训练，阳极组增加患侧大脑半球M1区阳极tDCS治疗，阴极组增加健侧大脑半球M1区阴极tDCS治疗，对照组给予假刺激。治疗前和治疗4周后，采用Fugl-Meyer评定量表上肢部分(FMA-UE)、Wolf运动功能测试(WMFT)和改良Barthel指数(MBI)进行评定。

结果治疗前，3组间FMA-UE评分、WMFT评分和MBI评分无显著性差异(F < 1.165, P > 0.05)。治疗后，3组FMA-UE评分、WMFT评分和MBI评分均较治疗前显著提高(|t| > 6.412, P < 0.001)，阳极组和阴极组各项评分均高于对照组(P < 0.05)，但阳极组与阴极组间比较无显著性差异(P > 0.05)。

结论阳极tDCS和阴极tDCS均可有效改善脑卒中后上肢功能中、重度瘫痪患者患侧上肢功能和日常生活活动能力。

关键词: 脑卒中, 经颅直流电刺激, 上肢

Abstract:

Objective To observe the clinical efficacy of anodal or cathodal transcranial direct current stimulation (atDCS and ctDCS) on upper limb function of stroke patients with moderate to severe upper extremity impairment.

Methods From January to September, 2022, 69 patients in Zhongda Hospital Southeast University were randomly divided into control group (n = 23), atDCS group (n = 23) and ctDCS group (n = 23). All the groups received conventional rehabilitation. Moreover, atDCS group received atDCS over the M1 area of the affected hemisphere, ctDCS group received ctDCS over the M1 area of the unaffected hemisphere, and the control group received placebo stimulation. Before and four weeks after treatment, they were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT) and modified Barthel index (MBI).

Results Before treatment, there was no significant difference in the scores of FMA-UE, WMFT and MBI among groups (F < 1.165, P > 0.05). After treatment, all the scores improved significantly in all the groups (|t| > 6.412, P < 0.001), and were higher in the atDCS group and ctDCS group than in the control group (P < 0.05), however, no significant difference was found between the atDCS group and ctDCS group (P > 0.05).

Conclusion Both atDCS and ctDCS could improve the upper limb motor function and activities of daily living of stroke patients with moderate to severe upper extremity impairment.

Key words: stroke, transcranial direct current stimulation, upper limb

中图分类号:

R743.3

蔡倩, 徐亮, 杨玺, 刘进, 马明. 不同电极经颅直流电刺激对脑卒中上肢功能康复的效果[J]. 《中国康复理论与实践》, 2023, 29(5): 521-526.

CAI Qian, XU Liang, YANG Xi, LIU Jin, MA Ming. Effect of anodal or cathodal transcranial direct current stimulation on upper limb function of stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 521-526.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	偏瘫侧别(左/右)/n	卒中类型(脑出血/脑梗死)/n
对照组	23	12/11	53.00±12.91	135.70±25.79	8/15	6/17
阳极组	23	10/13	55.04±13.47	142.22±25.04	10/13	8/15
阴极组	23	11/12	51.09±12.86	131.78±21.63	9/14	7/16
χ²/F值		0.340	0.526	1.089	0.365	0.411
P值		0.840	0.593	0.342	0.833	0.814

组别	n	治疗前	治疗后	t值	P值
对照组	23	21.57±2.81	26.30±2.87	-6.412	< 0.001
阳极组	23	21.26±3.14	35.17±2.73^a	-18.913	< 0.001
阴极组	23	22.22±3.49	35.48±3.12^a,b	-11.843	< 0.001
F值		0.551	73.881
P值		0.579	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	23	17.17±3.17	22.87±3.27	-7.130	< 0.001
阳极组	23	17.83±2.29	31.87±2.75^a	-21.750	< 0.001
阴极组	23	18.48±3.15	31.30±2.88^a,b	-16.248	< 0.001
F值		1.165	66.041
P值		0.318	< 0.001

组别	n	治疗前	治疗后	t值	P值
对照组	23	30.39±3.97	56.57±3.44	-26.455	< 0.001
阳极组	23	30.30±4.63	69.17±2.79^a	-39.078	< 0.001
阴极组	23	30.17±3.30	68.52±3.84^a,b	-41.444	< 0.001
F值		0.017	101.362
P值		0.983	< 0.001