经颅直流电刺激联合耳迷走神经电刺激对脑出血下肢运动功能的疗效

Effect of Transcranial Direct Current Stimulation Combined with Electrical Stimulation of Auricular Vagus Nerve on Lower Limb Motor Function after Cerebral Hemorrhage

目的:探讨经颅直流电刺激(tDCS)联合耳迷走神经电刺激(ta–VNS)对脑出血患者下肢功能的应用效果。方法:将2022年12月至2023年12月期间广东三九脑科医院收治的40例脑出血偏瘫患者以随机抽样法分为对照组(20例)、观察组(20例)。两组患者均采取常规康复治疗,对照组在行运动治疗前先进行tDCS,观察组在行运动治疗前,先进行tDCS,再进行ta–VNS。分别于治疗前及治疗4周后,采用三维步态分析评估系统分析患者的步行时下肢的步态时空参数,包括:站立相、摆动相、步长、步速、步频、跨步长、矢状面下肢关节活动度;Fugl–Meyer运动功能量表下肢部分(FMA–LE)分析患者下肢运动功能;Berg平衡评分量表(BBS)分析患者平衡功能并进行组间比较。结果:两组患者治疗前的三维步态分析指标、FMA–LE、BBS评分比较,差异均无统计学意义(P>0.05);两组患者治疗4周后,三维步态分析指标、FMA–LE、BBS分数较治疗前改善,且观察组的改善效果均优于对照组,差异均具有统计学意义(P<0.05)。结论:tDCS结合ta–VNS治疗可明显改善脑出血偏瘫患者的下肢运动功能,并改善其平衡和行走能力。

Objective To explore the effect of transcranial direct current stimulation(tDCS)combined with auricular vagus nerve stimulation(ta-VNS)on lower limb function in patients with cerebral hemorrhage.Methods A total of 40 patients with hemiplegia after cerebral hemorrhage admitted to Guangdong Sanjiu Brain Hospital from December 2022 to December 2023 were randomly sampled and divided into a control group(20 cases)and an observation group(20 cases).Both groups were given conventional rehabilitation treatment.The control group was given tDCS before exercise therapy,and the observation group was given tDCS and ta-VNS before exercise therapy. Before and after 4 weeks of treatment, the three-dimensional gait analysis and evaluation system was used to analyze the temporal and spatial parameters of lower limb gait during walking, including standing phase, swing phase, step length, step speed, step frequency, stride length, and sagittal lower limb joint mobility. Fugl-Meyer assessment for the lower extremity (FMA-LE) was used to analyze the motor function of the lower limbs. The Berg balance scale (BBS) was used to analyze the balance function of patients and compare between groups. Results There was no significant differences in the three-dimensional gait analysis index, FMA-LE and BBS scores between the two groups before treatment (P > 0.05). After 4 weeks of treatment, the three-dimensional gait analysis index, FMA-LE and BBS scores of the two groups were improved compared with those before treatment, and the improvement effects of the observation group were better than those of the control group, and the differences were statistically significant (P < 0.05). Conclusion tDCS combined with ta-VNS treatment can significantly improve the lower limb motor function of patients with hemiplegia after intracerebral hemorrhage, and improve their balance and walking ability.