虚拟现实训练对脑卒中恢复质量及血清炎性因子水平的影响

Effect of virtual reality training on the quality of stroke recovery and the levels of serum inflammatory factors

目的观察虚拟现实训练在脑卒中早期康复中的临床应用价值。方法选取2019年6月至2021年6月期间济南市中心医院收治的60例脑卒中患者为研究对象开展前瞻性研究,抽签随机分为观察组(男16例,女14例,年龄20~78岁)和对照组(男17例,女13例,年龄18~77岁),每组30例。其中对照组采用常规康复治疗,观察组在对照组基础上外加虚拟现实训练治疗,均持续治疗2周。评估两组治疗前后美国国立卫生研究院卒中量表(NIHSS)、Berg平衡量表(BBS)、Fugl-Meyer评估量表(FMA)、改良Barthel指数(MBI)评分,比较两组治疗前后炎性因子[白细胞介素-1β(IL-1β)、IL-6、肿瘤坏死因子-α(TNF-α)]水平,统计两组并发症发生情况。统计学方法采用t检验、χ^(2)检验。结果观察组、对照组治疗后NIHSS评分均低于治疗前[(10.79±1.46)分比(20.18±2.99)分、(15.78±2.26)分比(20.83±3.04)分],观察组治疗后BBS、FMA、MBI评分均高于治疗前[(28.34±3.97)分比(9.98±1.32)分、(52.83±7.41)分比(25.89±3.57)分、(67.84±9.68)分比(29.84±4.12)分],对照组治疗后BBS、FMA、MBI评分均高于治疗前[(20.76±2.89)分比(10.24±1.51)分、(37.28±5.34)分比(26.12±3.61)分、(52.76±7.89)分比(28.49±4.01)分],差异均有统计学意义(t=3.411、3.062、1.897、3.098、15.599、10.291、9.108、5.507,均P<0.05);观察组治疗后NIHSS评分低于对照组,且BBS、FMA、MBI评分均高于对照组,差异均有统计学意义(t=15.517、12.915、14.244、10.103,均P<0.001)。观察组治疗后IL-1β、IL-6、TNF-α水平均低于治疗前[(14.79±2.12)ng/L比(28.66±4.54)ng/L、(2.14±0.37)ng/L比(6.78±1.12)ng/L、(14.71±2.11)ng/L比(26.84±3.78)ng/L],对照组组治疗后IL-1β、IL-6、TNF-α水平均低于治疗前[(21.74±3.17)ng/L比(28.57±4.32)ng/L、(4.28±0.74)ng/L比(6.64±1.07)ng/L、(19.79±2.87)ng/L比(25.99±3.67)ng/L],差异有统计学意义(t=5.780、5.194、5.227、6.027、5.973、6.156,均P<0.05);观察组治疗后IL-1β、IL-6、TNF-α水平均低于对照组,差异均有统计学意义(t=4.451、21.641、11.932,均P<0.001)。观察组并发症总发生率为10.00%(3/30),低于对照组的33.33%(10/30),差异有统计学意义(χ^(2)=4.812,P=0.028)。结论虚拟现实训练能改善脑卒中患者神经功能缺损状况及平衡功能、躯体运动功能、日常生活活动能力,降低患者体内炎性因子水平,且安全性较好。

Objective To observe the clinical application value of virtual reality training in the early rehabilitation of stroke.Methods Sixty stroke patients admitted to Jinan Central Hospital from June 2019 to June 2021 were selected as the research objects to conduct a prospective study,and were randomly divided into an observation group(16 males and 14 females,aged 20-78 years)and a control group(17 males and 13 females,aged 18-77 years)with 30 cases in each group.The control group received conventional rehabilitation treatment,and the observation group received virtual reality training treatment on the basis of the control group,lasting for 2 weeks.The scores of National Institutes of Health Stroke Scale(NIHSS),Berg Balance Scale(BBS),Fugl-Meyer Assessment(FMA),and modified Barthel index(MBI)were evaluated before and after treatment,the levels of inflammatory factors[interleukin-1β(IL-1β),IL-6,and tumor necrosis factor-α(TNF-α)]before and after treatment were compared between the two groups,and the incidence of complications was statistically analyzed.t test andχ2 test were used for statistical analysis.Results The NIHSS score of the observation group and control group after treatment were lower than those before treatment[(10.79±1.46)points vs.(20.18±2.99)points,(15.78±2.26)points vs.(20.83±3.04)points],the BBS,FMA,and MBI scores of the observation group after treatment were higher than those before treatment[(28.34±3.97)points vs.(9.98±1.32)points,(52.83±7.41)points vs.(25.89±3.57)points,(67.84±9.68)points vs.(29.84±4.12)points],the scores of BBS,FMA,and MBI of the control group after treatment were higher than those before treatment[(20.76±2.89)points vs.(10.24±1.51)points,(37.28±5.34)points vs.(26.12±3.61)points,(52.76±7.89)points vs.(28.49±4.01)points],with statistically significant differences(t=3.411,3.062,1.897,3.098,15.599,10.291,9.108,and 5.507;all P<0.05).After treatment,the NIHSS score of the observation group was lower than that of the control group,and the BBS,FMA,and MBI scores were higher than those of the control group,with statistically significant differences(t=15.517,12.915,14.244,and 10.103;all P<0.001).The levels of IL-1β,IL-6,and TNF-αin the observation group after treatment were lower than those before treatment[(14.79±2.12)ng/L vs.(28.66±4.54)ng/L,(2.14±0.37)ng/L vs.(6.78±1.12)ng/L,(14.71±2.11)ng/L vs.(26.84±3.78)ng/L],the levels of IL-1β,IL-6,and TNF-αin the control group after treatment were lower than those before treatment[(21.74±3.17)ng/L vs.(28.57±4.32)ng/L,(4.28±0.74)ng/L vs.(6.64±1.07)ng/L,(19.79±2.87)ng/L vs.(25.99±3.67)ng/L],with statistically significant differences(t=5.780,5.194,5.227,6.027,5.973,and 6.156;all P<0.05).After treatment,the levels of IL-1β,IL-6,and TNF-αin the observation group were lower than those in the control group,with statistically significant differences(t=4.451,21.641,and 11.932,all P<0.001).The incidence of complications in the observation group was 10.00%(3/30),which was significantly lower than that in the control group[33.33%(10/30)],with a statistically significant difference(χ^(2)=4.812,P=0.028).Conclusion Virtual reality training can improve the neurological impairment,balance function,physical movement function,and activities of daily living in stroke patients,and reduce the levels of inflammatory factors,with good safety.