不同电流密度经颅直流电刺激对脑卒中患者上肢运动障碍疗效分析

Effect of transcranial direct current stimulation with different current density onupper limb motor disorder after stroke

目的对比分析不同电流密度经颅直流电刺激对脑卒中患者上肢运动障碍的疗效。方法选择2019年3月至2022年6月首都医科大学宣武医院收治的45例脑卒中后上肢运动障碍患者,随机予以低电流密度(0.028 mA/cm2,低密度组)、中等电流密度(0.057 mA/cm2,中密度组)和高电流密度(0.080 mA/cm2,高密度组)电刺激(每组各15例),于治疗前和治疗后1周采用Fugl‑Meyer上肢评价量表(FMA‑UE)和上肢动作研究测验量表(ARAT)评价上肢运动功能,改良Barthel指数(mBI)评价日常生活活动能力。结果不同电流密度组患者治疗后FMA‑UE(F=284.343,P=0.000)、ARAT(F=180.427,P=0.000)和mBI(F=487.159,P=0.000)评分均高于治疗前;各组间FMA‑UE(F=2.293,P=0.000)和ARAT(F=2.572,P=0.000)评分差异有统计学意义,其中高密度组和中密度组FMA‑UE(t=2.426,P=0.029;t=2.140,P=0.035)和ARAT(t=2.537,P=0.024;t=2.353,P=0.028)评分均高于低密度组。结论经颅直流电刺激可有效改善脑卒中患者上肢运动功能,尤以电流密度0.057和0.080 mA/cm2效果更佳。

Objective To explore the therapeutic effect of transcranial direct current stimulation(tDCS)with different current density on upper limb motor disorder in stroke patients.Methods A total of 45 stroke patients with upper limb motor disorder hospitalized in Xuanwu Hospital,Capital Medical University from March 2019 to June 2022 were selected and randomly divided into low current density stimulation group(low density group,0.028 mA/cm2),medium current density stimulation group(medium density group,0.057 mA/cm2),high current density stimulation group(high density group,0.080 mA/cm2),15 cases in each group.Upper limb motor function was evaluated by Fugl‑Meyer Assessment Scale for Upper Extremity(FMA‑UE)and Action Research Arm Test(ARAT)before and one week after treatment,and activity of daily living was evaluated by modified Barthel Index(mBI).Results After treatment of tDCS,FMA‑UE(F=284.343,P=0.000),ARAT(F=180.427,P=0.000)and mBI(F=487.159,P=0.000)scores in 3 groups were improved compared with those before treatment.FMA‑UE(F=2.293,P=0.000)and ARAT(F=2.572,P=0.000)scores were significantly different among 3 groups,FMA‑UE(t=2.426,P=0.029;t=2.140,P=0.035)and ARAT(t=2.537,P=0.024;t=2.353,P=0.028)scores in high density group and medium density group were higher than those in low density group.Conclusions tDCS is safe and effective in the treatment of upper limb motor disorder after stroke.Current densities of 0.057 and 0.080 mA/cm2 are more effective than those of 0.028 mA/cm2.