脑卒中患者偏瘫侧徒手指部感觉刺激前后上肢正中神经F波的变化研究

Changes of median nerve F-wave parameters after manual digitorum sensory stimulation of hemiplegic fingers in stroke patients

目的探讨偏瘫侧徒手指部感觉刺激(MDSS)对脑卒中患者上肢正中神经F波的影响。方法选择自2019年6月至2022年10月于安徽医科大学第二附属医院康复医学科进行康复治疗的30例脑卒中后偏瘫患者为研究对象, 患者偏瘫侧拇指屈肌改良Ashworth量表(MAS)等级均≥1级, 予其偏瘫侧MDSS治疗, 并检测双侧上肢(刺激前)及偏瘫侧上肢(刺激后即时)正中神经F波。结果与健侧相比, 刺激前患者偏瘫侧上肢正中神经F波波幅明显升高, 差异有统计学意义(P<0.05)。与刺激前相比, 拇指屈肌MAS等级≤2级患者刺激后偏瘫侧上肢正中神经F波波幅明显降低, 拇指屈肌MAS等级≥3级患者刺激后偏瘫侧上肢正中神经F波波幅明显升高, 差异均有统计学意义(P<0.05)。结论不同MAS等级患者中MDSS后偏瘫侧上肢正中神经F波波幅的变化显示, MDSS不仅可以抑制与肌痉挛有关的紧张性运动单位兴奋性, 在肌痉挛严重时还可提高主要与肌肉爆发力有关的运动性运动单位兴奋性。

Objective To evaluate the influence of manual digitorum sensory stimulation(MDSS)of hemiplegic fingers in median nerve F-wave in stroke patients.Methods Thirty patients with hemiplegia after stroke,admitted to Department of Rehabilitation Medicine,Second Affiliated Hospital of Anhui Medical University from June 2019 to October 2022 were selected;all patients had thumb flexor modified Ashworth scale(MAS)grading≥1.Hemiplegic MDSS was given;bilateral median nerve F-wave before MDSS and median nerve F-wave at the hemiplegic side immediately after MDSS were recorded.Results Compared with that at the healthy side before MDSS,amplitude of median nerve F-wave at the hemiplegic side was significantly increased(P<0.05).Compared with that before MDSS,amplitude of F-wave at the hemiplegic side after MDSS in patients with thumb flexor MAS grading<2 were significantly decreased(P<0.05),while that in patients with thumb flexor MAS grading≥3 was significantly increased(P<0.05).Conclusion Amplitudes of median nerve F-wave at the hemiplegic side in patients with different thumb flexor MAS grading show that MDSS can not only inhibit the excitability of tonic motor unit related to muscle spasm,but also enhance the excitability of kinetic-motor unit mainly related to explosive power in severe muscle spasm.