脑卒中偏瘫患者上肢H反射与痉挛的相关性研究

Correlation between H-reflex and Upper-extremity Spasticity after Stroke

目的观察脑卒中患者上肢H反射的H最大波幅/M最大波幅(Hmax/Mmax)、H发展斜率/M发展斜率(Hslp/Mslp)和H阈值/M阈值(Hth/Mth)等指标与痉挛的相关性。方法采用改良Ashworth量表(MAS)评定34例恢复期脑卒中患者上肢痉挛情况。对双上肢正中神经进行H反射检测,记录各项参数,并比较Hmax/Mmax、Hslp/Mslp和Hth/Mth。结果患侧上肢Hmax/Mmax为(0.35±0.17),健侧为(0.14±0.07),患侧高于健侧(P<0.05);患侧上肢Hslp/Mslp为(0.72±0.40),健侧为(0.26±0.22),患侧高于健侧(P<0.05);患侧上肢Hth/Mth为(0.93±0.14),健侧为(0.98±0.12),两者间无显著性差异(P>0.05);患侧上肢Hmax/Mmax与MAS评分呈线性正相关(r=0.608,P<0.05);患侧上肢Hslp/Mslp与MAS评分亦呈线性正相关(r=0.917,P<0.05);患侧上肢Hth/Mth与MAS评分不相关(r=-0.128,P>0.05)。结论 Hmax/Mmax和Hslp/Mslp可作为脑卒中上肢痉挛程度评价的电生理指标。

Objective To evaluate the relationship between the ratio of the maximal value of the H-reflex to the maximal value of the M response （Hmax/Mmax）, the ratio of the developmental slope of the H-reflex to the slope of the M response （Hsip/Msip）, and the ratio of the thresh- old of the H-reflex to the threshold of the M response （Hth/Mt0 and upper-extremity spasticity in stroke patients. Methods Upper-extremity spasticity in 34 stroke patients was assessed by modified Ashworth Scale （MAS）. H-reflex was recorded in flexor carpi radialis muscle on both sides. Hmax/Mmax, Hsip/Msip and Hsh/Mth in the spastic side were compared to the unaffected side. Results The mean of Hmax/Mmax （spastic side, 0.36±0.17; unaffected side, 0.14±0.07） and Hsip/Msip （spastic side, 0.72±0.40; unaffected side, 0.26±0.22） showed significant difference between 2 sides （P〈0.05）. The mean of Hth/Msh （spastic side, 0.93±0.14; unaffected side, 0.98±0.12） showed no significant difference （P〉 0.05）. nmJMmax, and Hsip.Msip were correlated positively with score of MAS in the stroke patients （r=0.608, P〈0.05; r=0.917, P〈0.05）, while there was no correlation between Hth/Mth and score of MAS （r=-0.128, P〉0.05）. Conclusion Hmax/Mmax and Hsip/Msip could be sensitive elec- trophysiologic parameters to evaluate upper-extremity spasticity after stroke.