经颅直流电刺激对脑卒中后上肢及手功能恢复的随机对照研究

Effect of transcranial direct current stimulation on upper limb and hand function in stroke:a double-blind randomized controlled trial

目的:探讨阳极经颅直流电刺激(a-tDCS)对脑卒中患者上肢及手功能恢复的影响。方法:96例脑卒中患者随机分为观察组49例、对照组47例,观察组给予a-tDCS,对照组给予a-tDCS假刺激,2组患者在此基础上均进行常规药物及常规康复治疗。在治疗前和治疗4周后,采用上肢Fugl-Meyer运动功能评定量表(FMA-UE)、WMFT评定量表(WMFT)、改良Barthel指数量表(MBI)及Brunnstrom评定量表对患者进行评定并统计治疗后不良反应的情况。结果:治疗4周后,2组患者FMA-UE、WMFT及MBI评分较治疗前均明显提高(均P<0.01),且观察组各项评分较对照组均明显提高(P<0.01,0.05);2组患者上肢及手Brunnstrom分期与治疗前比较均明显改善(均P<0.01),且观察组上肢及手Brunnstrom分期较对照组改善情况均更显著(P<0.01,0.05);观察组出现轻微不良反应,电极片放置处皮肤瘙痒1例、睡眠障碍1例;对照组头晕1例。以上不良反应患者均能耐受,且无需处理短时间自行缓解。结论:阳极经颅直流电刺激有助于改善脑卒中恢复期患者上肢及手的功能。

Objective:To evaluate the effect of combined anodal transcranial direct current stimulation(a-tDCS)and conventional rehabilitation training on upper and hand motor functions of patients with stroke.Methods:In a double-blind randomized controlled trial,96 patients with hemiplegia after stroke were randomly divided into two groups:treatment group(n=49)and control group(n=47).A-tDCS was given to the treatment group,and a-tDCS was given to the control group for false stimulation.On this basis,patients in both groups received conventional drugs and conventional rehabilitation treatment.Before and 4 weeks after treatment,patients were assessed with upper limb Fugl-Meyer motor function rating scale(FMA-UE),WMFT rating scale(WMFT),modified Barthel index scale(MBI)and Brunnstrom rating scale,and adverse reactions after treatment were counted.Results:After 4 weeks of treatment,FMA-UE,WMFT and MBI scores in both groups were significantly higher than those before treatment(all P<0.01),and all scores in the treatment group were significantly higher than those in the control group(all P<0.01,P<0.05).Brunnstrom stage of upper limb and hand in both groups was significantly improved as compared with that before treatment(all P<0.01),and the improvement of upper limb and hand Brunnstrom stage in the treatment group was more significant than that in the control group(P<0.01,P<0.05).Slight adverse reactions occurred in the treatment group,including skin itching at the place where the electrode was placed(1 case),and sleep disturbance(1 case).Dizziness occurred in one case in the control group.The patients with the above adverse reactions were able to tolerate,without treatment for a short time to relieve.Conclusions:A-tDCS could effectively improve the upper limb function in patients with hemiplegia following stroke,which may provide a better rehabilitation treatment for stroke.