经颅直流电刺激对亚急性期缺血性脑卒中患者上肢运动功能和体感诱发电位的影响

Effects of transcranial direct current stimulation on upper limb motor function and somatosensory evoked potential in stroke patients

目的:探讨经颅直流电刺激(tDCS)对亚急性期缺血性脑卒中患者上肢运动功能和体感诱发电位的影响。方法:选取脑卒中后上肢运动功能障碍患者96例,随机分为观察组47例和对照组49例,观察组给与tDCS和上肢常规康复训练,对照组给与tDCS假刺激和上肢常规康复训练。分别于治疗前、治疗4周后应用Fugl-Meyer运动功能评定量表上肢部分(FMA-UE)、Wolf运动功能测试量表(WMFT)、改良Barthel指数(MBI)及上肢正中神经诱发电位N20潜伏期和波幅对2组患者进行评估,并对2组患者的正中神经诱发电位N20测定结果变化和肢体功能变化的进行相关性分析,观察干预前后患者上肢运动功能与体感诱发电位的变化。结果:治疗4周后,2组患者的FMA-UE、WMFT、MBI评分较治疗前均显著升高,且观察组高于对照组,差异均有统计学意义(均P<0.05);观察组N20波幅较治疗前则增加(P<0.05);2组N20潜伏期组内、组间比较均无统计学差异;除治疗组WMFT差值与N20潜伏期差值呈正相关(r=0.305,P=0.037)外,其余均无相关性,2组患者偏瘫侧治疗前正中神经SEP N20测定结果与治疗4周后MBI、FMA-UE、WMFT各项量表评分均无相关性。结论:经颅直流电刺激可改善亚急性期脑卒中患者的上肢运动功能及体感诱发电位N20的波幅,SEP N20潜伏期变化和肢体功能WMFT评分变化具有一定的相关性。

Objective:To investigate the effects of transcranial direct current stimulation(tDCS)on upper limb motor function and somatosensory evoked potentials in patients with subacute ischemic stroke.Methods:A total of 96 patients with upper limb motor dysfunction after stroke were selected and divided into treatment group(n=47;tDCS+conventional upper limb rehabilitation training)and control group(n=49;tDCS pseudo-stimulation+conventional upper limb rehabilitation training)according to the random number table method.The Fugl-Meyer Assessment of Motor Function(FMA-UE),Wolf Motor Function Test(WMFT),modified Barthel index(MBI)and median nerve evoked potential N20(latency,amplitude)were used to evaluate the two groups before and 4 weeks after treatment.The results before and after intervention were observed and the correlation between upper limb motor function and somatosensory evoked potentials was analyzed.Results:After 4 weeks of treatment,the FMA-UE,WMFT,and MBI scores of the two groups were significantly increased by intra-group comparison and inter-group comparison(P<0.05).In the treatment group,the amplitude of N20 was increased within and between groups,but there was no significant difference in the latency between the groups.The correlation between the changes of median nerve SEP N20 measurement results and limb function changes in the two groups was analyzed.There was no correlation between WMFT difference and N20 latency difference in the treatment group,except that the difference of WMFT in the treatment group was positively correlated with the difference of N20 latency(r=0.305,P=0.037).There was no correlation between median nerve SEP N20 measurement results and MBI,FMA-UE and WMFT scores after 4 weeks of treatment in the two groups.Conclusion:Transcranial direct current stimulation can improve upper limb motor function and somatosensory evoked potential N20 amplitude in patients with subacute stroke.The latent changes of SEP N20 have a certain correlation with the changes of WMFT score of limb function.