脑卒中患者双下肢H反射的变化及其与痉挛指数的相关性

The study of H-reflex in stroke patients′ both lower extremities and its relation with composite spasticity scale

目的:研究痉挛期脑卒中患者双下肢胫神经H反射的变化及其和痉挛指数的相关性,并探讨其发生机制。方法:32例恢复期脑卒中患者,均存在不同程度的患侧下肢伸肌痉挛。将患者双下肢分为患侧和非患侧,分别给予肌电图胫神经H反射检查和患侧综合痉挛量表(CSS)评定,比较双侧H反射的改变,分析患侧H反射潜伏期和H/M比值和CSS评分的相关性。结果:患侧H反射潜伏期平均26.18±1.64ms,H/M比值平均0.53±0.22,患侧下肢CSS评分平均9.88±1.59;非患侧H反射潜伏期平均28.30±1.69ms,H/M比值平均0.36±0.19。双侧H反射的潜伏期和H/M比值比较,患侧潜伏期缩短,H/M比值增大,有显著性差异;患侧CSS评分和H/M比值显著正相关,直线回归方程为y=-0.54+0.11x,相关系数r=0.6329,(P<0.001)。结论:痉挛期脑卒中患者患侧H反射活跃,患侧H/M比值和CSS评分正相关,H/M比值是脑卒中后痉挛性偏瘫患者痉挛侧下运动神经元兴奋性评估的良好指标。

Objective：To study the changes of H-reflexes in stroke patients＇ both lower extremities and to investigate the relationship of the H-reflexes＇ parameters and composite spasticity scale （CSS） scores. Method： Thirty-two stroke patients in stage of recovery, existing spasm of gastrocnemius in various degree, accepted the H- reflex examination of electromyography in both lower extremities and CSS evaluation on affected extremity to analyse the changes of H-reflexes＇ latent period and H/M and its relationship with CSS scores. Results： The averaged Hreflexes＇ latent period of affected extremities was 26.18±1.64ms, the averaged H/M was 0.53±0.22, the averaged CSS scores was 9.88±1.59; The averaged H-reflexes＇ latent period of nonaffected extremities was 28.30±1.69ms, the averaged H/M was 0.36±0.19. There were significant differences between two extremities with respect to H-reflex. The latent periods of H-reflex were shortened and H/Ms were elevated at affected extremities. The CSS score and H/M of affected extremities were positive correlation with r=0.6329; Their linear regression formula was y=-0.54＋ 0.11x. Conclusion： It is suggested that H-reflex of affected extremities will be active after stroke and that H/M is a good marker to evaluate the excitability of spinal cord anterior horn motor neurons.