减重步行训练改善老年脑梗死偏瘫患者步行能力的局部脑血流灌注显像研究

Body-weight supported treadmill training for improving lower limb function in elderly hemiplegia patients after cerebral infarction

目的 通过单光子发射计算机断层显像（SPECT）局部脑血流半定量分析法,探讨减重步行训练（BWSTT）治疗老年脑梗死偏瘫患者下肢运动功能障碍的机制及SPECT在脑血管病研究中的价值.方法 选择7例脑梗死患者,给予10周综合康复治疗,分为三个阶段,即2周基线期（给予常规康复治疗）、6周干预期（给予常规康复治疗加BWSTT）和2周撤消期（给予常规康复治疗）.在治疗前、基线期末、干预期末和撤消期末采用10 m最大步行速度（MWS）和Berg平衡量表（BBS）进行功能评定,应用SPECT观察皮质局部脑血流的动态变化情况.结果 经2周基线期的治疗,患者10 m MWS和BBS评分无明显变化,差异无统计学意义（P＞0.05）;6周干预期末,MWS及BBS评分明显增高,差异有统计学意义（P＜0.01）;撤消期末,MWS及BBS评分均有所增高,但增高幅度小于干预期,差异无统计学意义（P＞0.05）;6周干预期末,患者大脑皮质的局部脑血流变化的差异有统计学意义（P＜0.01）.结论 BWSTT可以明显改善老年脑梗死患者的步行速度和平衡能力;SPECT能客观反映下肢运动功能的恢复与大脑皮质局部脑血流变化的关系,SPECT是研究脑卒中后下肢运动功能康复与脑功能重组之间关系的一种有效手段.

Objective To observe the effect of body-weight supported treadmill training （BWSTT） on the lower limb motor function of elderly hemiplegia patients with acute cerebral infarction using semi-quantitative analysis of regional cerebral blood flow （rCBF） through single photon emission computed tomography （SPECT）. Methods Seven patients with cerebral infarction were given comprehensive rehabilitation therapy for 10 weeks in three stages： a baseline period of 2 weeks （ conventional rehabilitation therapy）, an intervention period of 6 weeks （ conventional rehabilitation therapy plus BWSTT） and a withdrawal period of 2 weeks （conventional rehabilitation therapy）. During the intervention period the exercise duration increased gradually from 15 to 30 minutes, once a day, 5 times a week,for 6 consecutive weeks. Dynamic changes in rCBF in the cortex were observed with SPECT before and after treat ment. Results During the baseline period there was no significant change in average MWS （maximum walking speed） or BBS （ Berg balance scale） scores. During the intervention period both scores improved significantly. During the withdrawal period there were some changes in MWS and BBS scores, but they were not significant. There was a significant change in average rCBF in the cortex after treatment compared with before. Conclusions BWSTT is effective for improving the walking speed and balance of elderly patients with acute cerebral infarction. There is a positive correlation between the recovery of lower limb motor function and changes in rCBF in the cortex.