经皮穴位电刺激联合经颅直流电刺激对缺血性脑卒中后偏瘫痉挛状态及运动功能的影响

Effects of TEAS combined with tDCSS on spasticity and motor function in ischemic stroke with spastic hemiplegia

目的 探究经皮穴位电刺激(TEAS)和经颅直流电刺激(tDCS)对缺血性脑卒中后偏瘫痉挛状态及运动功能的影响。方法 将2021年1月至2023年8月中国人民武装警察部队特色医学中心收治的165例缺血性脑卒中后偏瘫患者纳入本次前瞻性研究,按照随机数字表法将其分成观察组(n=83)和对照组(n=82)。对照组患者给予常规康复治疗,观察组患者给予常规康复治疗+TEAS+tDCS治疗,共干预4周。比较两组患侧上下肢痉挛改善情况,干预前、干预4周后的Fugl-Meyer评分(包括上肢的FMA-UE评分和下肢的FMA-L评分)、改良的Barthel指数(MBI)、功能性步行量表(FAC)分级和10 m步行时间、患侧胫骨前肌、腓肠肌内侧头、腕伸肌和腕屈肌表面肌电均方根值(RMS)。结果 观察组上肢和下肢痉挛治疗的总有效率分别为93.98%、92.77%,均显著高于对照组(84.15%、81.71%),差异均有统计学意义(P<0.05)。观察组干预4周后的FMA-UE评分、FMA-L评分和MBI评分分别为(54.19±8.75)、(26.12±7.03)、(65.71±11.08)分,显著高于对照组[(42.41±8.52)、(20.05±6.67)和(54.18±10.82)分],差异均有统计学意义(P<0.05)。观察组干预4周后的FAC分级为(3.86±0.40)级,显著高于对照组[(3.06±0.37)级],而10 m步行时间为(59.33±6.17) s,显著短于对照组[(73.02±7.02) s],差异均有统计学意义(P<0.05)。观察组干预4周后的胫骨前肌、腓肠肌内侧头、腕屈肌和腕伸肌表面肌电RMS分别为(50.08±2.96)、(51.36±4.13)、(67.55±9.07)、(94.31±11.14)μV,显著高于对照组[(39.10±2.89)、(41.77±4.22)、(58.06±9.62)和(85.07±11.45)μV],差异均有统计学意义(P<0.05)。结论 TEAS+tDCS治疗缺血性脑卒中后偏瘫可显著改善患者患侧上下肢痉挛状态,提高患者的运功功能和步行能力。

Objective To explore the effects of transcutaneous electrical acupoint stimulation(TEAS)and transcranial direct current stimulation(tDCS)on spasticity and motor function in patients with post-ischemic stroke hemiparesis.Methods This prospective study included 165 patients with post-ischemic stroke hemiparesis who were admitted to Special Medical Center of Chinese People's Armed Police Forces from January 2021 to August 2023 and were divided into the observation group(n=83)and the control group(n=82)according to the random number table method.The control group received conventional rehabilitation treatment,while the observation group received conventional rehabilitation treatment combined with TEAS and tDCS treatment.The intervention lasted for 4 weeks.The improvement of spasticity in the affected upper and lower limbs,pre-and post-intervention Fugl-Meyer Assessment scores(including FMA-UE for the upper limb and FMA-L for the lower limb),modified Barthel index(MBI),functional ambulation category(FAC)grading,10-meter walking time,and surface electromyography root mean square(RMS)values of the tibialis anterior muscle,gastrocnemius medialis,wrist exTEASor,and wrist flexor on the affected side were compared.Results The total effective rates of spasticity treatment for the upper and lower limbs in the observation group were 93.98%,92.77%,respectively,which were significantly higher than those in the control group(84.15%,81.71%),the differences were statistically significant(P<0.05).The post-intervention FMA-UE score,FMA-L score,and MBI score in the observation group were(54.19±8.75),(26.12±7.03),(65.71±11.08)points,respectively,which were higher than those in the control group[(42.41±8.52),(20.05±6.67),(54.18±10.82)points],the differences were statistically significant(P<0.05).The post-intervention FAC grading in the observation group was(3.86±0.40)levels,which was higher than that in the control group[(3.06±0.37)levels],while the 10-meter walking time was(59.33±6.17)s,which was shorter than that in the control group[(73.02±7.02)s],the differences were statistically significant(P<0.05).The post-intervention RMS values of the tibialis anterior muscle,gastrocnemius medialis,wrist flexor,and wrist exTEASor in the observation group were(50.08±2.96),(51.36±4.13),(67.55±9.07),(94.31±11.14)μV,respectively,which were higher than those in the control group[(39.10±2.89),(41.77±4.22),(58.06±9.62),(85.07±11.45)μV],the differences were statistically significant(P<0.05).Conclusion TEAS and tDCS treatment can significantly improve spasticity in the affected upper and lower limbs,enhance motor function,and improve walking ability in patients with post-ischemic stroke hemiparesis.