F波、H反射在卒中后肢体痉挛疗效评估中的研究进展

Progress of F Wave and H Reflex in Effect Evaluation of Antispastic Treatment of Limb Spasticity in Post-stroke Patients

卒中后肢体痉挛是上运动神经元损伤导致高级中枢失去对脊髓牵张反射的抑制,脊髓反射性增高引起以牵张反射增强为特征的肌肉张力异常。肢体痉挛是卒中后常见并发症之一,严重影响了卒中患者功能康复。近年来涌现出各类改善卒中后肢体痉挛的治疗方法,但其疗效评价标准不一,其中以主观性量表评价为主。笔者搜集了近些年国内外卒中后肢体痉挛治疗的临床研究文献,发现F波、H反射相关参数等客观评价指标被越来越多地与主观评价量表相结合,运用到各类临床研究的疗效评价中。相对于H反射,F波具有更加灵敏的特点,能更好反映肢体肌张力的变化,常与改良Ashworth痉挛量表一起作为缺血性卒中后肢体痉挛疗效的评价指标。

Spasticity of limbs in post-stroke patients is a common abnormal muscle tone characterized by an enhancement of spinal cord stretch reflex.This is caused by the upper motoneuron injury leading to the loss of spinal stretch reflex inhibition from high-level central nervous system.Limb spasticity can seriously affect the functional rehabilitation of post-stroke patients.In recent years,various anti-spastic therapies emerged,but the evaluation criteria of antispastic effect are different,and these criteria are mainly subjective ones.The objective evaluation indexes such as F wave and H reflection were often used in combination with the subjective evaluation scales to evaluate the anti-spastic effect in recent clinical studies.However,compared to H reflex,F wave is more sensitive and can reflect the changes of limb muscle tone better.Hence,at present the modified Ashworth Scale combined with F wave are often used to evaluate the effect of anti-spastic treatment in post-stroke patients.