脑卒中偏瘫患者双侧正中神经的F波变化研究

Investigation of F wave elicited by electric stimulation of bilateral median nerves in stroke patients

目的 探讨脑卒中偏瘫患者双侧肢体的F波变化特点。方法 按Brunnstrom分级将 80例脑卒中偏瘫患者分成 3组 ,即第 1组 3 6例 ,第 2组 2 3例 ,第 3组 2 1例。 19例正常人为对照组。运用肌电图学的方法 ,检测 80例脑卒中偏瘫患者和对照组双侧肢体正中神经F波参数 ,并进行统计分析。结果 第 1组(BrunnstromI～II级 ) ,无论在动态还是静态下 ,卒中患者的患侧肢体的F波参数均明显降低 ,低于健侧肢体和对照组 (P <0 .0 5 ) ,而健侧肢体与对照组差异无显著性 ;第 2组 (BrunnstromIII～IV级 ) ,静态情况下卒中患者的患侧肢体的F波参数明显增高 ,高于健侧肢体和对照组 (P <0 .0 5 ) ,而健侧肢体与对照组差异无显著性 ,动态情况下卒中患者的健侧肢体的F波参数明显高于对照组 (P <0 .0 5 ) ,而患侧与健侧差异无显著性 ;第 3组 (BrunnstromV～VI级 ) ,卒中患者的患侧肢体的F波参数明显高于健侧肢体和对照组 ,其中波幅增高明显 (P <0 .0 5 ) ,出现率也增高 ,但无统计学意义 (P >0 .0 5 )。结论 脑卒中后运动模式的动态变化过程是一个异常运动模式的过程 ,它包括患侧和健侧的变化。

Objective To investigate the changes of the F wave elicited by electric stimulation of median nerves of both sides in strok e patients. Methods Eighty hemiplegic patients caused by stroke were recruited and allocated into 3 groups according to the classific ation of the patients with Brunnstrom′s 6 Stages of Recovery from hemiplegia. F wave elicited by stimulating the median nerve of both sides were recorded and a nalyzed, in terms of its amplitude and frequency under both static and dynamic c onditions (maximal anti- resistance contraction of the contralateral muscles). Nineteen healthy subjects served as control. Results For patients at the Brunnstrom′s stages I and II, both static and dynamic F wav e amplitude and frequency were significantly reduced ( P <0.05) in the involve d upper limb as compared with those of the controls and uninvolved side. the dif ference was not statistically significant between the uninvolved side and the co ntrols. In those at the Brunnstrom′s stages III and IV, the static F wave ampli tude and frequency of the involved side was significantly increased and higher ( P <0.05) than those of the uninvolved side and the controls, while the dynami c F wave parameters was significantly higher in the uninvolved side than those i n the controls ( P < 0.05), but there was no significant difference between th e two sides in the patients. In those at the Brunnstrom′s atages V and VI, both static and dynamic F wave amplitudes in the invoved side were significantly hig her than those in the uninvolved side and controls ( P <0.05), but no signific ant difference was revealed when the frequencise were compared among the two sid es and the controls ( P >0.05). Conclusion The resu lts of this study suggested that changes of F wave were characteristically relat ed to the motor functions of stroke patients. Further study is needed to evaluat e the relevance of our findings to the rehabilitation of stroke.