持续性电刺激对脑卒中患者步行重建的影响

Influence of the Sustained Electrical Stimulation on Gait Reconstruction in Stroke Patients

目的探讨持续性电刺激对脑卒中患者步行重建的影响。方法 2010年4月—2012年1月在我院门诊治疗的首次脑卒中发病患者48例,在常规步行训练中增加对股四头肌的持续电刺激,选取10 m作为测定距离,在无电刺激和有电刺激两种情况下进行最大步行速度和行走步数的测定。结果训练开始时有3例患者不能完成10 m步行训练,在增加了持续性电刺激后可以完成自主行走;1例患者转入我院治疗前已在其他医院进行了6个多月康复训练仍不能行走,在接受电刺激训练1个月后,可以使用支具完成自主行走。训练开始时常规步行训练者最大步行速度与电刺激者比较,差异有统计学意义(P<0.05);而步行步数比较差异无统计学意义(P>0.05)。训练结束后所有患者最大步行速度都达到20 m/min以上,这一步速可在无介助情况下进行自主行走,此时常规步行训练者最大步行速度及步行步数与电刺激者比较,差异均无统计学意义(P>0.05)。常规步行训练者及电刺激者训练结束时的最大步行速度及步行步数与训练开始时比较,差异均有统计学意义(P<0.05)。结论在脑卒中患者临床康复治疗过程中实施持续性电刺激,对提升步行能力具有正面作用,可有效提高脑卒中患者的最大步行速度。然而电刺激的疗效存在边界,随着患者步行能力的提高,电刺激的效果呈递减趋势。

Objective To analyze the impact of the sustained electrical stimulation （ES） on gait reconstruction in stroke patients. Methods Totally 48 patients were treated in our deparment due to the first onset of stroke from April 2010 to January 2012. Sustained ES was aaplied on the quadriceps femoris in addition to conventional gait training, with a determination distance of 10 meters. The maximum walking speed （MWS） and walking step numbers （WSN） were recorded. Results Three patients who could not walk at the beginning of training completed 10 m walking after ES. One patient who could not walk despite 6 - month training in other institutions was able to walk under the support of orthosis 1 month after ES training. MWS showed sig- nificant difference between ES group and conventional training group （ P 〈 0.05 ） , whereas WSN showed no such difference （ P 〉 0. 05 ）. Upon the completion of the training program, the MWS was over 20 m/min in all patients, which enabled the patients to walk without using orthosis. Furthermore, neither MWS nor WSN showed significant difference between the ES group and con- ventional training group （ P 〉 0. 05 ）. Compared with those at the beginning of training, both MWS and WSN significantly changed （P 〈 0. 05 ）. Conclusion The Sustained ES has positive impcat in stroke patients by increasing MWS and reducing WSN. However, such benefits show a margin effect： along with the improvement of the patients＇walking ability, the effect of electrical stimulation decreases.