血流限制联合运动训练对脑卒中患者下肢功能和步行能力的影响

Effects of blood flow restriction combined with exercise training on lower extremity and gait function in stroke patients

目的:探讨血流限制(blood flow restriction,BFR)联合运动训练对脑卒中患者偏瘫侧下肢功能与步行能力的影响。方法:34例脑卒中患者随机分为BFR联合运动训练组(BRE-ET)(试验组)和运动训练组(ET)(对照组)。患者在每日常规康复基础上,试验组接受运动训练和BFR联合运动训练,对照组接受每日2次运动训练。治疗前、治疗中(10天)、治疗后(20天)采用Brunnstrom分期、肌力(MMT)、肌张力(MAS)、主动关节活动度(AROM)、Fugl-Meyer评定量表-下肢部分(FMA-LE)、“起立-行走”计时测试(TUGT)、改良Barthel指数(MBI)对两组患者进行3次评估。结果:治疗20天后,两组偏瘫侧踝跖屈AROM与髋外展肌力与治疗前有明显改善(P<0.001),且试验组明显优于对照组(P=0.014;P=0.048)。两组FMA-LE、TUGT、MBI治疗前后均有明显改善(P<0.001)。治疗后试验组TUGT与治疗中相比差异有显著性意义(P=0.002)。结论:BFR结合运动训练较常规运动训练能更有效的改善脑卒中患者下肢功能,对步行功能、日常生活活动能力有更好临床治疗效果的发展趋势。

Objective:To investigate the effect of blood flow restriction combined with exercise training on hemiplegic lower extremity and gait function in stroke patients.Method:Totally 34 stroke patients were randomly divided into blood flow restriction combined with exercise training(BFR-ET)group and exercise training(ET)group.During 20-day trial period,experiment group received 20-minute BFR-ET and 30-minute ET per day,while control group received 30-minute ET twice per day.Pre-,mid-and after-treatment,they were evaluated with Brunnstrom Stage,manual muscle test(MMT),Modified Ashworth scale(MAS),Active range of motion(AROM),Fugl-Meyer assessment-lower extremities(FMA-LE),Time-up and Go Test(TUGT)and modified Barthel index(MBI).Result:There were greater improvements of ankle plantar flexion(P=0.014)and strength of hip abduction(P=0.048)of hemiplegic lower extremity in BFR-ET group than in ET group.The scores of FMA-LE、TUGT、MBI were markedly increased in all groups after treatment(P<0.001).The result of TUGT showed a significantly statistical difference between mid-treatment and after-treatment in BFR-ET group(P=0.002).Conclusion:Blood flow restriction combined with exercise training can improve lower extremity function than exercise training separately.There is a potential tendency of BFR-ET for increasing gait function and daily-living ability of stroke patients.