脑血流灌注断层显像在脑卒中偏瘫患者下肢强制性运动疗法疗效评价中的应用价值

Application of Regional Cerebral Blood Flow Tomography in Constraint-Induced Movement Therapy Appraisal among Hemiplegic Stroke Patients

目的观察下肢强制性运动疗法(CIMT)治疗前后局部脑血流(rCBF)灌注的变化,探索脑血流灌注断层显像在CIMT对脑卒中偏瘫患者下肢疗效评价中的应用价值。方法选取符合入选标准的脑卒中偏瘫患者共9例,对所有患者进行为期6周的CIMT治疗,治疗前后分别进行脑血流灌注断层显像,rCBF灌注半定量分析应用缺血灶放射性计数(L)与对侧相应脑组织放射性计数(N)的比值(L/N)表示,对比治疗前后缺血脑组织的rCBF灌注变化情况。同时在治疗前和治疗6周后,用10 m最大步行速度(MWS)评定患者的步行能力。结果治疗前L/N为(0.54±0.25)〔95%可信区间(0.45,0.68)〕,治疗后L/N为(0.98±0.52)〔95%可信区间(0.87,1.21)〕,治疗前后比较差异有统计学意义(P<0.01)。MWS从治疗前的(17.44±10.85)提高到(10.57±6.91)(P<0.01)。缺血灶的rCBF灌注改善情况与患者步行能力的提高情况一致。结论脑血流灌注断层显像显示缺血灶rCBF灌注的变化可有效评价CIMT对偏瘫患者下肢的治疗效果。

Objective To observe the change of regional cerebral blood flow（rCBF） before and after constraint-induced movement therapy（CIMT） treatment and to probe the clinical values of cerebral blood flow tomography in constraint-induced movement therapy appraisal among hemiplegic stroke patients.Methods Nine qualified hemiplegic stroke patients were enrolled and underwent CIMT therapy for a period of six weeks.The ratio of radioactivity countof the ischemia focus area（L） and radioactivity count of the normal side（N）was applied for semi-quantitative analysis of rCBF,which was compared before and six weeks after treatment.At the same time,walking ability was assessed through maximum walking speed（MWS） before and six weeks after treatment.Results L/N ratios were different before treatment（0.54±0.25）（95% confidence interval（0.45,0.68）） and after treatment（0.98±0.52）（95% confidence interval（0.87,1.21）） with statistical significance（P0.01）.MWS raised from（17.44±10.85）s/10 m before treatment to（10.57±6.91）s/10 m after treatment（P0.01）.Improvment of ischemia regional cerebral blood flow was consistent with that of walking ability.Conclusion Cerebral blood flow changes displayed by regional cerebral blood flow tomography may effectively evaluate therapeutic effects of CIMT.