神经肌肉电刺激对脑卒中患者上肢功能影响的随机研究

Neuromuscular electrical stimulation for promoting functional recovery of an upper extremity after stroke： A randomized controlled trial

目的探讨神经肌肉电刺激（NMES）对脑卒中偏瘫患者上肢功能的影响。方法将37例初发脑卒中患者分层后随机分为NMES组（n=19）和对照组（n=18）。2组常规治疗相同，NMES组同时给予NMES治疗，电极分别放在患侧肩外展肌群和伸腕肌群处；刺激频率为30Hz，脉宽为300μs，通电／断电比为5s／5S，波升／波降比为1s／1S，强度为0～90mA，随患者感觉而定。治疗每天1次，每次30min，每周5次，共3周。入选患者分别于治疗前、治疗2周和3周后进行评定：采用Fugl-Meyer运动功能评定量表（FMA）中上肢部分评定上肢运动功能，采用改良Barthel指数（MBI）评定日常生活活动能力；23例（NMES组11例，对照组12例）在治疗前及治疗3周后接受体感诱发电位（SEP）评测。结果治疗3周后，NMES组与对照组FMA评分、MBI评分以及SEP参数比较，差异均有统计学意义（P〈0．05）。结论NMES可以改善脑卒中患者偏瘫上肢运动功能，提高日常生活活动能力。

Objective To assess neuromuscular electrical stimulation （NMES） for enhancing functional re- covery in an upper extremity after stroke. Methods Thirty-seven survivors of a first stroke were randomly divided into a NMES group and a control group. The NMES group （ n = 19） received stimulation on the supraspinatus and deltoid muscles and on the wrist extensor using surface electrodes. The stimulation current intensity was set to produce full shoulder and wrist extension with a duty cycle of 5 s on and 5 s off. The stimulus pulses had a symmetric biphasic waveform with a frequency 30 Hz, a pulse width of 300 μs, and amplitudes ranging between 0 to 90 mA. The current amplitude was adjusted according to each subject＇s sense of comfort. Treatments lasted for 30 min, once daily, 5 d per week for 3 weeks. Both groups received the same standard rehabilitation program. Measurements included Fugl- Meyer motor assessment （FMA） for upper extremity function, somatosensory evoked potential （SEP） for motor func- tion, as well as modified Barthel index （MBI） scores for the activities of daily living. Measurements were recorded before treatment, and after 2 and 3 weeks of treatment. Results Before treatment, there was no significant differ- ence between the two groups in terms of age, stroke severity, or the outcome measures. Significant differences were found in the FMA, MBI and SEP scores of the two groups after 3 weeks of treatment. Conclusion After three weeks of NMES on the affected upper extremity of subjects with early stroke, the patients＇ motor function had im- proved.