脑卒中急性期及亚急性期运动诱发电位对上肢运动功能康复的预测价值

The predictive value of motor evoked potential on motor function rehabilitation of upper limbs in acute and subacute phase of stroke

目的探讨运动诱发电位(MEP)对脑卒中后上肢肌力恢复和运动功能预后的预测价值。方法前瞻性纳入2019年4月至2020年4月该院神经外科住院的首次脑卒中患者38例,急性期和1个月后记录MEP,6个月后采用上肢肌力和运动评估量表(手的运动部分)评价MEP对肌力恢复和运动功能的预测价值。结果38例患者中急性期28例(73.6%),1个月后36例(94.7%)患肢引出MEP波形。在引出MEP波形的患者中患肢所有肌肉MEP/复合肌肉动作电位波幅比均低于健肢。此外,即使急性期MEP波形缺乏,患肢近端肌的肌力仍有恢复的可能。小指展肌、肱二头肌、指总伸肌MEP对功能恢复预测价值优于对肌力恢复的预测价值。存在MEP波形对上肢肌力恢复和功能恢复的预测价值急性期特异度、阳性预测值、阳性似然比均高于1个月后,灵敏度均低于1个月后(除小指展肌外)。结论MEP对脑卒中患者后上肢肌力与功能的恢复具有显著的预测价值,且对功能恢复预测价值优于对肌力恢复的预测价值。将MEP与临床评估相结合可对患者上肢功能恢复起到较好的帮助作用。

Objective To investigate the predictive value of the Motor Evoked Potentials(MEP)for the rehabilitation of muscle strength and the prognosis of motor function of the upper limbs after stroke.Methods A total of 38 patients with first stroke hospitalized in the neurosurgery department of the hospital from April 2019 to April 2020 were included prospectively.MEP were recorded at the acute stage and one month later.After six months,the upper limbs Muscle strength and Motor Assessment Scale(the hand movement part)were used to evaluate the predictive value of MEP for muscle strength rehabilitation and motor function.Results Among the 38 patients,the MEP waveforms of 28 patients(73.6%)in acute phase and 36 patients(94.7%)after one month were induced.In patients with MEP present,the amplitude ratio of MEP/compound muscle action potential(CMAP)of all muscles of the affected limb was lower than that of the uninjured limb.In addition,the proximal muscle(deltoid)strength of the upper limbs may recover even if the MEP absent in acute phase.The predictive value of MEP for the function rehabilitation of abductor digitorum,biceps and extensor digitorum communis was better than that for the strength rehabilitation.In the acute phase,MEP present showed predictive value for muscle strength and function rehabilitation of upper limbs,the specificity,positive predictive value and positive likelihood ratio were all higher than that after one month,and the sensitivity was all lower than that after one month(except abductor of the little finger).Conclusion MEP has significant predictive value for the recovery of upper limb muscle strength and function after stroke,and the predictive value of functional recovery is better than that of muscle strength recovery.MEP combined with clinical evaluation can play a better role in the recovery of upper limbs function in patients.