肌肉能量技术联合高压氧治疗脑卒中恢复期患者的效果及对上肢运动功能、日常生活活动能力的影响

Effect of muscle energy technology combined with hyperbaric oxygen in the treatment of convalescent stroke patients and its effect on upper limb motor function and daily living activity

目的 探讨肌肉能量技术联合高压氧治疗脑卒中恢复期患者的效果及对上肢运动功能、日常生活活动能力的影响。方法 本研究为回顾性分析,选择2021年1月至2023年3月阜阳市人民医院收治的80例脑卒中恢复期患者作为研究对象,按照治疗方法不同将其分为对照组和观察组,每组各40例。对照组予以常规康复治疗,观察组在此基础上,加用肌肉能量技术联合高压氧治疗。比较两组临床疗效,比较两组治疗前及治疗4周后上肢Fugl-Meyer运动功能量表(FMA)、改良Barthel指数(MBI)、改良Ashworth量表(MAS)评分,并检测与比较两组治疗前及治疗4周后的肱肌、肱二头肌和肱桡肌的剪切波弹性成像(SWE)值、血清γ-氨基丁酸、谷氨酸水平及大脑中动脉峰值流速(Vs)、平均流速(Vm)、血管阻力指数(RI)。结果 观察组治疗有效率为92.50%,高于对照组(75.00%),差异有统计学意义(P<0.05)。观察组治疗4周后的上肢FMA评分、MBI评分分别为(56.48±6.22)、(79.50±6.47)分,均高于对照组[(39.85±6.06)、(71.28±6.31)分],MAS评分为(1.03±0.16)分,低于对照组[(1.40±0.50)分],差异均有统计学意义(P<0.05)。观察组患者治疗4周后的肱肌、肱二头肌和肱桡肌的SWE值分别为(25.40±6.37)、(29.03±5.22)、(21.63±3.43) kPa,均低于对照组[(42.33±8.93)、(41.23±6.14)、(26.43±4.09)kPa],差异均有统计学意义(P<0.05)。观察组治疗4周后血清γ-氨基丁酸水平为(9.11±1.92)μmol/L,高于对照组[(5.81±1.92)μmol/L],谷氨酸水平为(189.27±19.73)μmol/L,低于对照组[(224.27±29.14)μmol/L],差异均有统计学意义(P<0.05)。观察组治疗4周后的大脑中动脉Vs、Vm分别为46.90±6.37、36.33±4.92,均高于对照组(40.45±6.52、32.15±4.88),RI为36.70±2.26,低于对照组(73.60±3.25),差异均有统计学意义(P<0.05)。结论 肌肉能量技术联合高压氧治疗能够增加脑卒中恢复期患者的临床获益,进一步改善上肢运动功能,提高日常生活活动能力,值得临床推广使用。

Objective To explore the effect of muscle energy technology combined with hyperbaric oxygen in the treatment of convalescent stroke patients and its effect on upper limb motor function and daily living activity.Methods This study was a retrospective analysis.Eighty stroke recovery patients admitted to Fuyang People's Hospital from January 2021 to March 2023 were selected and divided into the control group and the observation group according to the different treatment methods,with 40 cases in each group.The control group received routine rehabilitation treatment,while the observation group received muscle energy technology combined with hyperbaric oxygen therapy on this basis.The effective rates of the two groups was compared,and perform upper limb Fugl Meyer motor function assessment(FMA),modified Barthel index(MBI),and modified Ashworth scale(MAS)scores before and after 4 weeks of treatment in the two groups were compared.The shear wave elastography(SWE)values of the brachialis,biceps,and brachioradialis muscles and the levels of serumγ-aminobutyric acid,glutamic acid levels,peak flow velocity(Vs),mean flow velocity(Vm),and vascular resistance index(RI)of the middle cerebral artery before and after 4 weeks of treatment in the two groups were measured and compared.Results The effective rate of treatment in the observation group was 92.50%,which was higher than that in the control group(75.00%),the difference was statistically significant(P<0.05).After 4 weeks of treatment,the upper limb FMA score and MBI score of the observation group were(56.48±6.22)and(79.50±6.47)points,respectively,which were higher than those of the control group[(39.85±6.06)and(71.28±6.31)points],and the MAS score was(1.03±0.16)points,which was lower than those of the control group[(1.40±0.50)points],the differences were statistically significant(P<0.05).After 4 weeks of treatment,the SWE values of the brachialis,biceps,and brachioradialis muscles in the observation group were(25.40±6.37),(29.03±5.22),and(21.63±3.43)kPa,respectively,which were lower than those in the control group[(42.33±8.93),(41.23±6.14),and(26.43±4.09)kPa],and the differences were statistically significant(P<0.05).After 4 weeks of treatment,the serum level ofγ-aminobutyric acid in the observation group was(9.11±1.92)μmol/L,which was higher than that in the control group[(5.81±.92)μmol/L],glutamate level was(189.27±19.73)μmol/L,which was lower than that in the control group[(224.27±29.14)μmol/L],and the differences were statistically significant(P<0.05).After 4 weeks of treatment,the Vs and Vm of the middle cerebral artery in the observation group were 46.90±6.37 and 36.33±4.92,respectively,which were higher than those in the control group(40.45±6.52 and 32.15±4.88),and the RI was 36.70±2.26,which was lower than that in the control group(73.60±3.25),the differences were statistically significant(P<0.05).Conclusion Muscle energy technology combined with hyperbaric oxygen therapy can increase the clinical benefit of stroke patients in the convalescent stage,further improve the upper limb motor function and enhance the ability of daily living activities,which is worthy of clinical promotion.