经皮穴位电刺激对脑卒中患者上肢功能及运动诱发电位的影响

Effects of transcutaneous accupoint electrical stimulation on upper limb function and motor evoked potential in stroke patients

目的:探讨经皮穴位电刺激(TAES)对脑卒中恢复期患者偏瘫上肢功能及运动诱发电位(MEP)的影响。方法:41例脑卒中恢复期患者随机分为TAES组(n=21)和安慰刺激组(n=20)。TAES组采用TAES治疗仪治疗于患侧上肢的肩髃、曲池、外关和合谷4个穴位行频率100Hz、脉宽0.2ms和患者可耐受最大强度的电刺激治疗,1次/d,1h/次,5次/周,连续3周;安慰刺激组接受TAES安慰刺激(即仅连接TAES治疗仪,不开机)。治疗前、治疗第2周、治疗第3周时行患侧上肢Fugl-Meyer评分和改良Barthel指数评分(MBI)评定及患侧皮质MEP的检测。结果:治疗前两组患者基线资料类似(P>0.05)。治疗第2周和第3周两组患者的FMA-UE、MBI评分及MEP与治疗前比较均改善(P<0.05);TAES组FMA-UE、MBI评分及MEP的改善较安慰刺激组明显(P<0.01)。结论:TAES治疗能改善脑卒中恢复期患者上肢功能,提高生活自理能力,推测其机制可能与增强脑卒中患者患侧大脑皮质兴奋性有关。

Objective：To investigate the effects of transcutaneous acupoint electrical stimulation（TAES） in enhancing upper limb function and motor evoked potential（MEP） in subjects with stroke.Method：Forty-one subjects with first stroke were randomly assigned into 2 groups：TAES group and placebo stimulation group. All subjects received the same standard rehabilitation. In TAES group, Model KD-2A stimulator was applied with 0.2ms pulses, at 100 Hz within the subject＇s tolerance level on the 4 acupuncture points（LI15, LI11, SJ5 and LI4） in the affected upper limb for 60 min, 5 days a week for 3 weeks; The time and the course of treatment in placebo stimulation group was as well as the TAES group, but no current output for each treatment. All subjects in the 2 groups received standard rehabilitation program. Measurements including Fugl- Meyer motor assessment（FMA- UE）, modified Barthel index（MBI）,the latency, amplitude and central motor conduction time（CMCT） of motor evoked potential（MEP） on affected side were recorded before treatment, after 2 and 3 weeks＇ treatment.Result：After 3 weeks treatment,the function scores and the latency, amplitude and CMCT of MEP on affected side of the two groups improved significantly（P〈0.05）. The function scores and the latency, amplitude and CMCT of MEP on affected side in TAES group improved significantly than those in placebo group（P〈0.05）.Conclusion：Transcutaneous acupoint electrical stimulation could improve the excitability of motor cortex of affected brain area and promote the recovery of upper limb function significantly.