经皮穴位电刺激对脑卒中患者脑局部血流量的影响

The effects of transcutaneous electrical nerve stimulation on regional cerebral blood flow in patients with stroke

目的观察单次(1 h)经皮电神经刺激(TENS)治疗对脑卒中患者即刻脑局部血流量(rCBF)的影响。方法将22例脑卒中初发患者随机分为TENS治疗组和对照组。2组患者分别接受2次单光子发射计算机断层成像(SPECT)检查,2次检查间隔1 h,TENS治疗组在2次检查之间接受1 h的TENS治疗,治疗部位选取偏瘫侧上肢的肩髃、曲池、外关、合谷穴以及下肢的阳陵泉、足三里、解溪和昆仑穴等8个穴位。对照组2次检查之间不做TENS治疗,仅休息1 h。采用半定量值、不对称指数和变化率来分析治疗前、后患侧病灶及其周边区域以及病灶对称部位及其周边区域(镜像部位)rCBF的变化。结果单次TENS治疗后, TENS治疗组与对照组相比,放射性计数、半定量值和变化率明显增加,不对称指数明显减低,差异均有统计学意义(P<0．05)。结论单次TENS治疗可以改善脑卒中患者患侧和健侧大脑半球的rCBF,且以改善患侧rCBF为主,推测TENS对脑卒中偏瘫患者肢体功能的改善作用可能与TENS增加rCBF,激活脑细胞的功能活动有关。

Objective To investigate the therapeutic effects of one session of transcutaneous electrical nerve stimulation （TENS） on regional cerebral blood flow （rCBF） in stroke patients. Methods Twenty-two stroke patients were randomly divided into a treatment group and a control group. The rCBF changes in all patients were examined using single positron emission computerized tomorgraphy （SPECT）. Scans were performed twice with an interval of 1 h. The patients in the treatment group were treated with TENS during the 1 h interval. Eight acupuncture points on the paralyzed limb （ LI15, LI11, LI4, SJ5 on the upper limb and ST36, ST41, GB34, BL60 on the lower limb） were treated, rCBF changes in the affected hemisphere, as well as at mirror sites on the affected hemisphere, were analyzed in terms of their semi-quantity value, asymmetry index and the percentage change over the two sessions. Results The radioactivity counts, semi-quantity values and percentage changes were significantly greater in the TENS group, while the asymmetry index was significantly lower than that in the control group. Conclusion TENS can increase rCBF in both the affected and unaffected hemispheres of stroke patients. That TENS improves motor function after stroke may be related to increasing the rCBF levels and stimulating functional activity in the brain cells.