经皮耳迷走神经电刺激结合康复机器人训练对脑卒中患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2023.06.009

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (6): 691-696.doi: 10.3969/j.issn.1006-9771.2023.06.009

经皮耳迷走神经电刺激结合康复机器人训练对脑卒中患者上肢功能的效果

郑莉¹^,²^,³, 鲍治诚², 张琪², 任绪艳¹, 苏敏¹^,³()

1.苏州大学附属独墅湖医院康复医学科，江苏苏州市 215000
2.昆山市第一人民医院康复医学科，江苏昆山市 215300
3.苏州大学康复研究所，江苏苏州市 215000

收稿日期:2023-03-30 修回日期:2023-05-29 出版日期:2023-06-25 发布日期:2023-07-14
通讯作者: 苏敏(1978-)，女，汉族，江苏苏州市人，博士，教授、主任医师，主要研究方向：神经康复。E-mail： sumin@suda.edu.cn
作者简介:郑莉(1990-)，女，汉族，江苏张家港市人，主管治疗师，主要研究方向：神经康复。
基金资助:
1.国家自然科学基金项目(82272594);2.江苏省自然基金面上项目(BK20211088);3.国家重点研发计划课题(2022YFC2009706)

Effect of transcutaneous auricular vagus nerve stimulation combined with robot-assisted therapy on upper limb function of stroke patients

ZHENG Li¹^,²^,³, BAO Zhicheng², ZHANG Qi², REN Xuyan¹, SU Min¹^,³()

1. Department of Rehabilitation Medicine, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu 215000, China
2. Department of Rehabilitation Medicine, the First People's Hospital of Kunshan, Kunshan, Jiangsu 215300, China
3. Institute of Rehabilitation, Soochow University, Suzhou, Jiangsu 215000, China

Received:2023-03-30 Revised:2023-05-29 Published:2023-06-25 Online:2023-07-14
Contact: SU Min, E-mail: sumin@suda.edu.cn
Supported by:
National Natural Science Foundation of China(82272594);Jiangsu Provincial Natural Fund (General)(BK20211088);National Key Research and Development Program(2022YFC2009706)

摘要/Abstract

摘要：

目的探讨经皮耳迷走神经电刺激(taVNS)结合康复机器人训练对亚急性期脑卒中患者上肢功能恢复的影响。
方法选取2022年3月至2023年3月独墅湖医院和昆山市第一人民医院亚急性期脑卒中患者60例，随机分为常规组(n = 20)、机器人组(n = 20)和联合组(n = 20)。3组均行常规治疗，包括药物治疗、物理疗法和作业治疗，机器人组行假taVNS联合手功能康复机器人进行训练，联合组行taVNS联合手功能康复机器人进行训练，共4周。分别于治疗前后比较Fugl-Meyer评定量表上肢部分(FMA-UE)评分及其手指部分评分、患侧腕背伸肌和指伸肌收缩时的肌电均方根值(RMS)以及经颅磁刺激运动诱发电位(TMS-MEP)潜伏期和振幅。
结果治疗后，各组FMA-UE及其手指部分评分、腕背伸肌和指伸肌RMS、TMS-MEP潜伏期和振幅均较治疗前改善(t > 2.099, P < 0.05)，联合组各项指标最优(F > 9.106, P < 0.001)。
结论 taVNS结合康复机器人能促进中枢神经系统重塑，进一步改善脑卒中患者上肢运动功能。

关键词: 脑卒中, 经皮耳迷走神经电刺激, 康复机器人, 上肢, 运动功能

Abstract:

Objective To investigate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) combined with robot-assisted therapy on upper limb function of subacute stroke patients.
Methods From March, 2022 to March, 2023, 60 subacute stroke patients from Dushu Lake Hospital and the First People's Hospital of Kunshan were randomly divided into control group (n = 20), robot group (n = 20) and combined group (n = 20). All the groups received conventional treatments including medication, physical therapy and occupational therapy; the robot group received sham taVNS combined with hand robot-assisted therapy; while the combined group received taVNS combined with hand robot-assisted therapy, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and hand part, the root mean square (RMS) electromyography of the extensor carpi radialis and extensor digitorum muscles during contraction, and the latency and amplitude of transcranial magnetic stimulation motor-evoked potential (TMS-MEP) before and after treatment.
Results After treatment, the scores of FMA-UE and hand part, RMS of the extensor carpi radialis and extensor digitorum muscles, and latency and amplitude of TMS-MEP improved in all the groups (t > 2.099, P < 0.05); and they were the best in all indicators in the combined group (F > 9.106, P < 0.001).
Conclusion taVNS combined with robot-assisted therapy can promote central nervous system remodeling and further improve upper limb function in stroke patients.

Key words: stroke, transcutaneous auricular vagus nerve stimulation, robot-assisted therapy, upper limb, motor function

中图分类号:

R743.3

郑莉, 鲍治诚, 张琪, 任绪艳, 苏敏. 经皮耳迷走神经电刺激结合康复机器人训练对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 691-696.

ZHENG Li, BAO Zhicheng, ZHANG Qi, REN Xuyan, SU Min. Effect of transcutaneous auricular vagus nerve stimulation combined with robot-assisted therapy on upper limb function of stroke patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 691-696.

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组别	n	性别(男/女) /n	年龄/岁	病程/d	患侧(左/右)/n	性质(梗死/出血)/n
常规组	20	11/9	58.20±11.83	19.85±7.10	12/8	8/12
机器人组	20	10/10	59.50±12.10	21.00±7.50	9/11	10/10
联合组	20	12/8	60.10±13.07	20.85±7.64	11/9	11/9
χ²/F值		0.404	0.124	0.142	0.938	0.934
P值		0.817	0.884	0.868	0.626	0.627

组别	n	治疗前	治疗后	t值	P值
常规组	20	20.50±4.11	27.35±5.17	4.702	< 0.001
机器人组	20	21.25±4.09	33.40±6.07^a	8.987	< 0.001
联合组	20	21.55±4.21	41.25±7.08^a,b	10.126	< 0.001
F值		0.342	25.600
P值		0.712	< 0.001

组别	n	治疗前	治疗后	t值	P值
常规组	20	1.50±0.51	5.50±3.05	5.946	< 0.001
机器人组	20	1.45±0.51	9.50±2.67^a	13.313	< 0.001
联合组	20	1.40±0.50	11.50±2.65^a,b	17.554	< 0.001
F值		0.193	23.910
P值		0.825	< 0.001

组别	n	治疗前	治疗后	t值	P值
常规组	20	15.62±4.20	43.33±6.34	18.558	< 0.001
机器人组	20	16.11±4.72	52.56±7.12^a	16.463	< 0.001
联合组	20	15.83±4.11	63.62±7.38^a,b	27.256	< 0.001
F值		0.064	42.589
P值		0.938	< 0.001

组别	n	治疗前	治疗后	t值	P值
常规组	20	13.92±3.91	35.53±6.12	16.410	< 0.001
机器人组	20	14.23±3.86	43.95±6.43^a	17.942	< 0.001
联合组	20	13.79±4.11	56.32±7.14^a,b	23.168	< 0.001
F值		0.064	50.575
P值		0.938	< 0.001

经皮耳迷走神经电刺激结合康复机器人训练对脑卒中患者上肢功能的效果

Effect of transcutaneous auricular vagus nerve stimulation combined with robot-assisted therapy on upper limb function of stroke patients

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组别	n	治疗前	治疗后	t值	P值
常规组	20	25.16±1.36	24.21±1.21	2.165	0.043
机器人组	20	24.91±1.23	23.32±1.14^a	6.421	< 0.001
联合组	20	25.25±1.32	22.43±0.99^a,b	6.822	< 0.001
F值		0.354	12.689
P值		0.703	< 0.001

组别	n	治疗前	治疗后	t值	P值
常规组	20	0.54±0.16	0.65±0.17	2.099	0.049
机器人组	20	0.55±0.13	0.81±0.21^a	4.206	< 0.001
联合组	20	0.57±0.17	0.95±0.27^a,b	6.096	< 0.001
F值		0.115	9.106
P值		0.891	< 0.001

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