经皮迷走神经刺激联合任务导向训练改善卒中后偏瘫患者上肢功能的研究

Transcutaneous auricular vagus nerve stimulation combined with task-oriented training to improve upper extremity function in post stroke hemiplegia

目的:探讨经皮耳迷走神经刺激(transcutaneous auricular vagus nerve stimulation,taVNS)联合任务导向性训练对卒中后偏瘫患者上肢功能及脑可塑性的影响。方法:将40例卒中后偏瘫患者随机分配至试验组(n=20)或对照组(n=20)。试验组接受taVNS联合任务导向性训练,而对照组仅接受任务导向性训练。在基线、治疗结束后分别用运动诱发电位(motor evoked potentials,MEP)、上肢Fugl-Meyer运动功能评估量表(Fugl-Meyer assessment upper extremity,FMA-UE)、偏瘫上肢功能测试香港版(functional test for the hemiplegic upper extremity,FTHUE)、手臂动作调查测试(action research arm test,ARAT)、改良Barthel指数(modified Barthel index,MBI)、疲劳严重度量表(fatigue severity scale,FSS)对患者进行评定,同时对治疗过程中患者出现的不良反应进行监测。结果:两组FMA-UE、FTHUE、ARAT、MBI、FSS评分在基线无显著性差异(P>0.05),经21天治疗后,两组除FSS外其余指标均较基线提高(P<0.05),且试验组FMA-UE、FTHUE、ARAT、MBI(作业能力)得分优于对照组(P<0.05)。两组健侧MEP潜伏期、波幅以及患侧MEP引出率在基线无显著差异(P>0.05),治疗后试验组健侧MEP潜伏期较对照组缩短(P<0.05),患侧MEP引出率高于对照组(P<0.05),而两组间波幅无显著差异;试验组健侧MEP潜伏期缩短与FMA-UE、FTHUE、MBI(作业能力)改善程度的相关系数分别为-0.705、-0.458、-0.654,具有显著性差异(P<0.05)。结论:taVNS联合任务导向性训练可以通过调节运动皮层的可塑性改善卒中后偏瘫患者的上肢运动功能。

Objective:To explore effects of transcutaneous auricular vagus nerve stimulation(taVNS)with task-oriented training(TOT)on upper extremity function and brain plasticity in post stroke hemiplegia patients.Method:Forty patients with stroke hemiplegia were randomly assigned to the experiment group(n=20)and the control group(n=20).The experiment group received taVNS combined with TOT,while the control group received only TOT.At baseline and at the end of treatment,the patients were assessed with motor evoked potentials(MEP),the Fugl-Meyer assessment upper extremity(FMA-UE),the Hongkong version of functional test for the hemiplegic upper extremity(FTHUE),the action research arm test(ARAT),the modified Barthel index(MBI),and the fatigue severity scale(FSS).The side effects were monitored during the treatment.Result:There were no significant differences in FMA-UE,FTHUE,ARAT,MBI and FSS between the two groups at baseline(P>0.05).After treatment,all the functional outcomes except FSS in both two groups increased significantly compared with baseline(P<0.05),and the FMA-UE、FTHUE、ARAT、MBI(occupational ability)scores in the experiment group were significantly higher than those in the control group(P<0.05).There were no significant differences in the latency,amplitude and induced rate of motor evoked potential(MEP)at baseline between the two groups(P>0.05).Compare with the control group after treatment,the latency of contralesional MEP in the experiment group was significantly shorter than that in the control group(P<0.05),and the induced rates of ipsilesional MEP were significantly higher(P<0.05),but there were no significant differences in contralesional amplitudes between the two groups.There was a significant correlation between the changes of contralesional MEP latency and the changes of FMA-UE(r=﹣0.705),FTHUE(r=﹣0.458),MBI in occupation(r=﹣0.654)in the experiment group(P<0.05).Conclusion:taVNS combined with TOT can improve upper extremity motor function in patients with stroke hemiplegia by modulating plasticity of motor cortex.