神经肌肉电刺激联合康复训练对脑卒中48例神经功能、上肢运动功能及血清脑源性神经营养因子、中枢神经特异蛋白的影响

Influences of neuromuscular electrical stimulation combined with rehabilitation training on neurological function,upper limb motor function and serum BDNF and S100-βin 48 cases of cerebral stroke

目的探讨神经肌肉电刺激(NMES)联合康复训练对脑卒中病人神经功能、上肢运动功能及血清脑源性神经营养因子(BDNF)、中枢神经特异蛋白(S100-β)的影响。方法选择荆州市第五人民医院2020年4月至2022年4月收治的96例脑卒中病人,以随机数字表法分成训练组(n=48)、联合组(n=48),均予以常规药物治疗,在此基础上训练组开展康复训练,联合组实施NMES联合康复训练治疗,治疗时间均为12周。于治疗前、治疗6周及12周后通过中国卒中量表(CSS)、上肢动作研究测试(ARAT)分别判定病人神经功能、上肢运动功能,测定患侧腕关节背伸时主动活动度(AROM)。同时测定病人治疗前、治疗12周后血清BDNF、S100-β水平,并对两组上述指标进行比较。结果两组CSS评分均随治疗时间增加而逐渐降低(P<0.05),ARAT评分均随治疗时间增加而逐渐增高(P<0.05),AROM均随治疗时间增加而逐渐增大(P<0.05),且时间和组间均有交互作用(P<0.05),其中联合组治疗12周后CSS、ARAT评分及AROM分别为(5.31±1.34)分、(34.73±6.21)分、(14.59±3.16)°,均明显优于训练组的(6.94±1.59)分、(31.81±5.47)分、(11.06±2.74)°(P<0.05);治疗12周后,两组血清BDNF水平均高于治疗前(P<0.05),血清S100-β水平均低于治疗前(P<0.05),且联合组血清BDNF、S100-β水平分别为(18.83±4.52)μg/L、(0.27±0.06)μg/L,均明显优于训练组的(15.76±3.39)μg/L、(0.35±0.11)μg/L(P<0.05)。结论对脑卒中病人实施NMES联合康复训练,可有效调节血清BDNF、S100-β水平,明显改善神经功能、上肢运动功能,显著增大AROM。

Objective To investigate the influences of neuromuscular electrical stimulation(NMES)combined with rehabilitation training on neurological function,upper limb motor function,serum brain-derived neurotrophic factor(BDNF)and central nervous system-specific protein(S100-β)in patients with cerebral stroke.Methods From April 2020 to April 2022,96 cerebral stroke patients admitted to the Fifth People's Hospital of Jingzhou were selected and divided into a training group(n=48)and a combined group(n=48)by the random number table method,and all of them were treated with conventional medication.On this basis,the training group underwent rehabilitation training,and the combined group underwent NMES combined with rehabilitation training treatment,and the treatment time was 12 weeks.Before treatment,after 6 weeks and after 12 weeks of treatment,the Chinese Stroke Scale(CSS)and the Action Research Arm Test(ARAT)were used to determine the neurological function and upper limb motor function of the patients,and the active range of motion(AROM)of the affected wrist in dorsal extension was measured.Moreover,the levels of serum BDNF and S100-βwere measured before treatment and after 12 weeks of treatment,and the above indicators were compared between the two groups were compared.Results The CSS scores of both groups gradually decreased with increasing treatment time(P<0.05),the ARAT scores and AROM gradually increased with increasing treatment time(P<0.05),and there was an interaction effect of time and group(P<0.05).After 12 weeks of treatment in the combined group,the CSS,the ARAT scores and the AROM scores were(5.31±1.34)points,(34.73±6.21)points,and(14.59±3.16)°,respectively,which were significantly greater than those iin the training group[(6.94±1.59)points,(31.81±5.47)points,and(11.06±2.74)°,respectively](P<0.05).After 12 weeks of treatment,the levels of serum BDNF levels in both groups were greater than those before treatment(P<0.05),the serum S100-βlevels were lower than those before treatment(P<0.05),and the serum BDNF and S100-βlevels in the combined group were(18.83±4.52)μg/L and(0.27±0.06)μg/L,respectively,which were significantly greater than those in the training group[(15.76±3.39)μg/L and(0.35±0.11)μg/L](P<0.05).Conclusion NMES combined with rehabilitation training for cerebral stroke patients can effectively regulate serum BDNF and S100-β levels, obvi-ously, improve neurological function and upper limb motor function, and significantly increase AROM.